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Home My WebLink AboutBEAR PARK LT 12 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 LEGAL DESCRIPTION t"~t~ Well ~ AbsorPtion area Dwelling PER~T NO, ~ Z Manufacturer Material No. of compartments Liq, capacity in gallons~ Inside length Width Liquid depth [ ~ IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well ~ /~ Dwelling PERMIT NO. ~ - ~ Manufacturer Material Liquid capacity in gallons Well I Foundation I Nearest Iotl~ne PER~T~O. ~ :, Nc. of lines Length of each Icne Total length of lines Trench wide. Distancebetweenline~]A ~ :~ Top of tile to finish grade ~1 ~aterial beneath tile i Total effective abso~onll~area ~ Length Width D~pth PERMIT NO. Tg~e of crib Crib diameter depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Clas~ ~ep¢~_ Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Buddmg foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING INSTALLER .', REMARKS APPROVED. ~,~,8~ ~9~.~ ........ DATE LEGAL 72-013 (Rev. 3/78) ENV: F'OI II IENTAL PROTECTION DIEPAR'TMENT OF HEAL. TH AND I [ <'x~ 8;25 I.~ S'I'REIET, ANCHORAGE~ AK 9950 J. .... 4: ~,~ EE: L.L.. F:" E::E F;~ ~ ]:: T' :'E R M I T 1'40: ~A'I"E ISSUED: :},_,(..) 64.,J 10/0 :t./85 ~PF'I.... I C'.ANT: ~DI) RESS: ',01'4 T A C'1" P H 0 N E: :IRA KRUGER % S&S ENGINEERING ~ -' ~ "" AK 99577 ANCIdOb~AbE., 694-2979 .EGAL DESCRIF': SUBDIVISION: BEAR PARK LOT: 12 SECTION: 4 TOWNSHIP: t5N RANGE~ tW .OT SIZE: '46563 (SD, FT. OR ACRES) lAX BEDROOMS: 3 BLOCK:: NA .isted be].c~w are the options available 'Lo you in designing yoLu' septic ~ystem. Choose the option that best fits your site. .... r R ET: N C:] 14 B F2: [) W . D t? (4 flEP"I"H TO PIPE BOTTOM (FT.) 4.0 )RAVEI.. DEPTH (FT,,) 9. () 'BTAL DEPTH (FI".') 1~,, 0 ;RAVEl .... WIDTH (F]".) 2.5 )RAVEL LENGTH (F:'T.) 50.0 )RAVEl_ VOLUME (CU. YDS. ) 44,, 0 'ANK S I ZE (GALS) 1~ 000. o ** ;C) IL RA"FING (SD:FT. /BR) 299 4.0 4.0 0.5 3.5 4.5 7.5 25. () 5.0 47.() 97.0 ~.* 43.6 '71.9 000.0 *~' 1.,00().0 ** 2.57 2.99 .~..~. GRAVEL LEEt`4GTH > 75 FT, REQUIRES MUL"FIF'I_E RUNS (NOT EXCEE:DING '75 FT. EACh,) · ~-~ TANK MUST F'IA',4'E AT LEAST TWO COMPARTMEN'TS cert. ify that: 1,, I am familiar with the requirement, s for' on-site sewers' and wells as set forth by the Municipal:i.'ky of Anchorage (MOA) and the State of Alaska. 2.. I will inst..all the system in accopdance with all MOA codes and r'egulations, and in compliance wit. h the design criteria of this permit. 3. I w:~].l, adhepe to all MOA and State of Alaska requipements fop the set bacl-:: distance~ From any ex:i. sting well, wastewaten disposal system on public sewer'age system on.this or any adjacent or ngar'by lot. 4. I understand that:, this permit :i.s valid f~)r a maximum OF 3 bedrooms and any enlar'gemer~t will require an additional permit. F A LIF'T STATION IS II`4STALLED IN AN AREA 'COVERED BY MOA BUILDING CODES, HEN (1) AN EL. EC~L' PERMIT A~D INSPECTION MUST BE OBTAINED~ (2) AS-BUIL..TS III...L.. NOT BEE AF:'F'~]VED/WITHOU'T AN EI..ECTRICAL INSPECTION REPORT~'AND (75) 'TIDE :I...ECTRIC, AL"'W~'~D~/)(:~A I..ICE:I`4SED ELECTRIC:lAN. ' , ,,' ............ ...... .......... ........................................................ .......... IF'PI.... :1: CAN'I" ~'""~~ '. ' ........................................ ............ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: {"Z.. LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 19 20 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water After Monitoring? Date: SITE IJLAN / Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__~' (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS, ~ 72-008 (Rev. 4/85) CERTIFY THAT '~HIS TEST WAS PERFORMED IN DURbiN Dmt[i~c Co. I./t,J I~LII I1 L/II, I LLI Ilt Time Drill Lo~I Casinc~ Mile 1.2, Lucas Road P.O. Box 871348 Wasilla, Alaska 99687 (907) Name: Address: City: Job Location: · Crew: ~.~- · · Date: Notes: Depth Well Lo~ 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (~--L~\ _ {.~..~,~ _ -~ ~¢. NAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~t-,-,~-~ ~-1, ~',. ,~ Mailing address Day phone Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will 'be held for pickup. NUMBER OF BEDROOMS: ~ ",/ TYPE OF WATER SUPPLY: Individual well ~/ Community well Public water NOTE: MUNICIPALITY OF ANC-.HOEAGE ENI/IROI~91ENTAL SERVICES DtVI$1ON JUL 0 7 1996 RECEIVED 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 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. Nameof Firm [ o ~b~l c ~/-.-l~,~ -~ ~-- Phone fl-:7~ ~ ~ / ~ Address ,~; ~ ~' / ~-~ ~ ~ Engineer's signature ' I~,LckC~~I ' Date ~'//~ / DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for .. bedrooms, with the following stipulations: Additional Comments By: Date 7- ~z/_... -~'~ 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 engineerlregistered 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 #21 Municipality of Anchorage DEPARTMENT OF HEALTH & H_U. MAN SERV~iwiC~?U~ Environmental Services uivision '~O. ~/~fl.N/.N. 2_ ,, 0~~ 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4.7.43/" ~RVlc~$ Health Authority Approval Checklist LegalDescription: /,!#7' I~t ~au( ~OU~,- ParcelI.D.: A. WELL DATA Well type Log present (Y/N) Total depth / Sanitary seal (Y/N) .. FROM WELL LOG Date oftest Static water level / Well production RECEIVED If A. B. or C, attach ADEC letter. ADEC water system number /,~ m m ~/ Date completed ~ /~"_~ - >1211 Casing height (above ground) , Wires properly protected (Y/N) AT INSPECTION §.p.m, ,~, g,p,m, WATER SAMPLE RESULTS: Coliform'~ ~/~/a~/~ Nitrate ~. ,'~ ~' i't~- Other bacteria Date ofsmnpl~: Coll~oted by: ~ · B; SE~IC~OLD~G TANK DATA = Foun~fion cle~out fire) . ~ Depression ff~ ~ m~gh water ~ ff~ Date of Pumping ~ /~4~Pumper ~ ~ $ C. ABSOR~ION'~LD DATA Dateins~led ~W~ Soilrating (g.p.d./~2orfl2~) ~ ~ System~e I/ , , 0 ' LenVh ~O~ Width3b / E Effective abso~tion ~ea ~ Me,toting Tubepresentff~ ~ Depression over field ff~ Date of adequa~ test b~V/~ Resffits ~ass~l) ~ For ~ b~ooms Fl~d dep~ in abso~on field before-test (in.); ~ ~ l~ately ~r/~g~. wat'dtaaded (in.): Fluid depth ~(ins,) Minutes later: ~w~ Abso~fioarat~= ~'~ g.p,d. Peroxide ~ea~ent ~ast 12 months) (Y~ , ~ ff yes, give Date installed Manhole/Access.([./N)~, High water ala~'m !e~/e'l at* 1 Cycles tested SEPARATION] SEPARATION D }ISTANCES Size in gallons "Pump on" level at* *Datum Receipt Number Rev. 8/95 OSS: haa.v}k.doc "Pump off" level at* STANCES FROM WELL ON LOT TO: ! Septic/holding ta~ k on lot ] O flo ; On adjacent lots .~' Absorption field ol lot ] [ ~ I ; On adjacent lots Public sewer mmn~ ~ ~A Public sewer manhole/cleanout Sewer/septic semi ce line ~ ~ ~ / Lffi station s~~ON ~Sr~NC~S ~O~ S~mC~O[~INa r~N~ O~ [Or ~O: Building foundatk ~n ~ ~ t Prope~ line ~ O / Abso~tion field Water mai~se~i~ line ~ ~ I Surface water/dr~nage N Wells on adjacent lots SEP~A~ON DiSTANCE ~OM ABSOR~ON ~E~ ON LOT TO: I Bulling foun~t~n ¢ Water m~se~ice line ]NI Driveway, p~hnffvehicle storage area Cu~aindrain [ ~ ~ Wells on adjacent lots ~/~O ] ENG~ER'S ~ERTIFICATION I certi~ that I h~e determined thru field inspections and review of Municipal ~ ,~ dhat in confortnance ~th MOA ~ guidelines in effect on this date. ' " Signature ' I -~ Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. La b o r a t o ~ D iv i$ ion r_~'.~,~"~'.~'~'~'~'~-~-~,.~,.~-~r~-.~,,~..~.~.tjt~jjjjjjtt~jjjj~~. Drinking Water Analysis Report for Total Coliform Bacteria w..otter 0rive A~chorage, AK 9951 8-1 605 READ INSTRUCTIONS ON REVERSE ~IDE BEFORE COLLECTING SAM'PLE Tel: (907) 562-2343 Phone s~umber I'a:~ ~'~umber Cay State Z~p Code ~ ;end Result~ ~3 Sendlnvolce ~;omp~ny Name C~ ~e Code , Fax: 1907) 561-5301 BE COMPLE'TED BY LABORATORY Analysis shows this Water SAdMPLE to be: ~ SatisfactoO' UnsatisfaCtory [] Sample'~ver 30 hours old, results may be unreliable [] Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analysis Began ,~,,,.,^dd,., Analytical Method: ..lia-"'Membrane Filter r~ MMO-MUG * Number of colonies/100 mi. Lab A~,. Ref. No. Result* ~ Routine , Q Treated Water Sent toA.D.E.C.. (~). Fbks Jun [] [] Repeat Sample (for routine sample ~ Untreated Water Faxed with lab ref. no. ) Date: ~--)q Time: [] Special Purpose Time' Collected Client notified of unsatisfactory results: S A~LP L E LOCATION Collected By [] [] L~}6 ! 2 B{~Cl.f' ~r k .I :35 4Cltt"~ Phoned Spoke with Faxed Pit,sc Print Date: _ Time: Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E. Coil Membrane Filter: Direct Count (~ Colonies/100 mi · Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filter Results/., ---, -- Coliform/100 mi Reported By /'~-b Date 6'~-~[' ~c~ Time. (::)c~/ hrs T,'VTC · Tt., Numer,tu.~ ro Ct,unt CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Report CT&E Ref.# Client Sample ID Matrix 962484.962484001 Lot 12 Bear Park Drinking Water PWSID 0 Sample Remarks: Collected Date 06/20/96 Technical Director: Stephen C. Ede Parameter Nitrate-N Total Coliform Results 2.33 0 QC Qual PQL Units 0.200 mg/L 0 col/lOOmL Method Allowable Prep Analysis Init Limits Date Date EPA 353.2 06/24/95 Elizabeth SM18 92228 06/20/96 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 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 Application Date //~ /- ~'"" 1. GENERAL INFORMATION (a) Legal Description' (include lot, block, subdivision, section, townsh~ipj range) Location (address or directions) (b). Applicant Name ItT..~. I~[-/-~.)d.~,~YL~., Telephone: Home '2v~- ~..~i~' Applicant Address Business L.~ - ~-~ ~[~_p ENGINEERING FIRM PROVIDING ..,SPECTIONS, TESTS, FILE SEARCH, DAT, ,ND 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 alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ .................. Telephone . SRB 196X. Address ~ ._ ~. ....... ,,-.. , .,~.~-.~ Date DHEP APPROVAL Approved for ~/'~'~"' bedrooms by ~ Approved ~ Disa~oved Terms of Conditional Approval Con~/~nal -' CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval c(~rtificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does 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) WELL DATA Well Classification Well Log Present~/N) Date Completed Total Depth [~/'~'~; Cased to ~'~.('~' ~ Depth of Grouting Static Water Level ['"~ ~ Casing Height Above Ground Electrical Wiring in Conduit~)/N) Separation Distances from Well: .u.,c,...,. o;..c.o..o; HEALTH AUTHORITY APPROVAL (HAA) 264-4720 Description:.. '.. Legal ~ ~------~ [~ ~'~ If A, B, C, D.E.C. Approved (Y/N) ~/~ Yield Pump Set At |/~ / Sanitary Seal on Casing~N) Depression Around Wellhead (Y~) To Septic/I-~31~mg Tank on Lot ~. ~ ~- ; On Adjoining Lots To Nearest Edge of Absorption Field or) Lot 1 [ ~, ~.----; On Adjoining Lots To Nearest Public Sewer Line ~ [~' To Nearest Public Sewer Cleanout/Manhole ~/,~ ' Water Sam pie Collected by Water Sam pie Test Results Comments To Nearest Sewer Service Line on Lot ,~-'~1'~--'~ ~:::~~r'-~ ;Date !l~'O~ ~ B. SEPTIC/HeL-131/~I3 TANK DATA Date Installed /~ '~"~y"~iSiz; I. ~ No. of Compartments ~- Standpipes(~N) Air-tight Caps(~N) Foundation Cleanout I~N) ~a~;~Last Pumped ~'--~ ~ Depression over Tank (Y~GD Pumping/Maintenance Contract on File ~. , ; for ' r,3 / (Y/N) F'3/'~/ Temporary Holding Tank Permit (Y/N) .~_ Holding Tank High-Water Alarm (Y/N) To Property Line To Water Main/Service Line Course Separation Distances from Septic/He~lm~ Tank: To Water-Su pply Well L~· ! To Building Foundation To Disposal Field ~. To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIEL Soils Rating in Abso Date Installed Width of Field DATA ~tion Strata '~_~1 ~ ~==,- ~ -~ Square Feet of Abso ation Area Depression over Fiel (Y~ Results of Last Ade( acy Test Separation Distance from Absorption Field: I To Water-Supply Wlll To Building Foundal~on , Lot / ~[~ To Water Main/Servibe Line To Stream/Pond/La~ ~/or Major Drainage Course To Driveway, Parkin Comments __ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Le Tested for Electrical Codes (Y/I~ Comments ** Check Permitted I certify that I have c Signed ~ Co m Da~;~[.E Receipt No. Date of.Payment , Amo~nt:$ '' Page 2 of 2 72-026 (11/84) Type of System Design Length of Field ~L Depth of Field ~ ~-'-~ ~ Gravel Bed Thickness ~ ,.~.~ [4 V '-'"'~ Standpipes Present CP/N) Datepf Last Adequacy Test 4~.I~--~"~.~-~ Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cu~tbank (if present) vel at Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA edroom Rating Against HAA Request ** cked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ' ~HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC~ ' TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTEF~ 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Water System Name (*) See h on back Phone No. Mailing Address State City Mo. Day Year Zip Code SAMPLE TYPE: E3"-Routine r-I Check Sample (for routine sample with lab ref. no. El Special Purpose ~ [] Treated Water - ,~- Untreated Water SAMPLE NO. 1 2 3 4 5 LOCATION I Time Collected I TO BE COMPLETED BY LABORATORY I Analysis shows this Water SAMPLE to be: /J~Satisfactory ~ [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: ID Fermentation Tube ID Membrane Filter Co,acted Lab Ref. No. Result* Analyst ! r-r-J i FT'1 I r-r-1 j FT'I *No. O! colonial/100 mi or NO. of Posture ~OrllOnl _. READ ~ tUCTIONS VlPLE o~'~22o Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:. Direct Count Verification: LTB Final Membrane Filter Results Reported By ~,"'~/~-~ ~ BGB Date Time: TNTC = Too Numerous To Count Coilformll00ml Collformll00ml p.m.