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HomeMy WebLinkAboutHILLSIDE PARK PUD LT 15 Municipality of Anchorage Page __of_ 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: ~ibO ~ZO0~'O PID Number: C) Nama:~-AC-K ~ ~N ~A (~V~ Wastewater System: D New ~ Upgrade Address: ~ ~. ~ +~ ~,. ABSORPTION FIELD Phone: No. of~edrooms: ~ Deep Trench ~ Shallow Trench ~ed ~ Mound ~ Other Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION . ~ ~/s~.~t. /, Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above~,or~g~nal grade: Ft. Gravel~olength:~ ~ Ft. ' Gravel depth: Number of lines: Distance between lines: New ~ Upgrade ~"~/ Et. ~ ~ Ft. WELL: Classification (Private, A,B,C): ~ Tota Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: . , ', Date installed: Yield: G~MIPump s~'at: Ft. Ca:lng Height Above Grou;~: TANK SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding =ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines ' ~~' Material: Number of Compartments: su,.c~ LIFT STATION Water I b~+ Ibc'+ ~/~ w/~ ~ot ¢ Size in gallons: J Manufacturer: I Ourt~Jn Drain ~ O ~ ~ O ~ ~ ~ ~ ~ 'ump Make & Model Electrical inspections performed by: Remarks: BENCH MARK Location and Description:  Assumed Elevation: Ft, ~ENGINEER'S SEAL Inspecbonsperformed by: I~, 1~ ~~ Dates: lst~ """"'"" '" ~~ icnael c. ~naerson Department of Hea~ and Human Services approval ~; %, Rewewed and approved by: Date: ~ /2-~z ,t~.," '~</0F.,'*~ow,~o~ 72-013 (1/91) MOA 25 ?"HE I~x 4~ ,~PP,'evv wv ! 2~40 = 8oo.r~,, rt. Per~it No. ~W ~ZO©~O Page of 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 LegalDescription: /-- /5 /////-~/~' /~:~,,~/~' /OLJ.D PIDNo.: O/~/ZZS'2- / \ // ~ADE.. ¢3°0 ~, R~S SEAL E. Anderson 4361 - E 72-013 A (2/91) MOA 25 LOT 15 HILLSIDE PARK PUD 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 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW920080 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:LOVE JACK & SONJA OWNER ADDRESS:5600 EAST 4TH AVE. ANCHORAGE, AK DATE ISSUED: 5/11/92 EXPIRATION DATE: 5/11/93 PARCEL ID:01512252 LEGAL DESCRIPTION: HILLSIDE PARK PUD LT LOT SIZE: 21788 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALU CONSTRUCTION MUST .E IN ACCORDANCE ~ITH: a-/ _~ ~Z'~ ~ 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 (iSAACS0). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS SYSTEM MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVE D ENGINEER'S DESIGN DATED 05/02/92, AND ANY DEVIATION THEREF ROM MUST APPROV,,50 Y DHHS PROIU,,, cONSTRUCTION. RECEIVED BY:.~ ISSUED BY: DATE: ://J'9 DATE:~ ON SITE SYSTEM IMPACT L15 BL - Hillside Park PUD Subd. Installation of an on site bed type wastewater system for this lot should have little if any impact on the surrounding properties due to: 1. The soil type and absence of water in the test hole monitoring tube during breakup, as the soil provides a good condition for natural percolation with a more impermeable bottom layer to spread the effluent distribution below the gravel (GP) soils. 2. The lot is served by a community water system with no neighboring wells. 3. Due to the topography of the lot and surrounding area being undeveloped there should be no impact of drainage caused by constructing an on site system on this lot. 4. There are no existing wastewater systems close by on adjacent lots and the reserve space is quite adequate. If you have any questions please contact me at 561-5829. Yours Truly, Michael E. Anderson, P.E. -F/~AcT A 18' LOT t5 HILLSIDE PARK PUD Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST S SEAL~ PERFORMED FOR: //7/~4~",~AJ ~-~ ~7~' DATE PER; LEGAL DESCRIPTION: 1 2 3 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water Alter Monitoring? Dale: 1'4 -/- /z /J SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop Z//1/~2..~ 0 0 ' ~ " -- / ~ ,' ~ ,, ~ ~,~ I~ e I" PERCOLATION RATE . TEST RUN BETWEEN . (minutes/inch) PERC HOLE DIAMETER -- FT AND ~ ~'' FT PERFORMED BY: /~). /lO ~V~ ~ ~ , '~~'-~¢-'""~C~RT,F¥ THAT .THIS TEST WAS PERFORMED IN AOCORDANCE WlTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE' DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SEAL) PERFORMED FOR: DATE PER LEGAL DESCRIPTION: /-* ~/.~ 1 2 3 4- 5 6 7 8 9 Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20~ COMMENTS WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water A~ tOk°~ Date: ,~"/?/'~2. Monitoring? Gross Net Depth to Net Reading Date Time Time Water Drop o o - ~ ,, /35" ~0 ~ ~ ~ 3, 5" I" PERCOLATION RATE -- TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND ~ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~/A~--~-E~ ~------(~) i~-~'r', DATE PE LEGAL DESCRIPTION: Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth to Water After Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop / o -- PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND -~' ~' FT PERFORMED BY: J/~/' m ¢ J~'~4~.~ ~__?d , ~'~-'//~'4~'~,,"~'~CERTIFY THAT/'THIS TEST WAS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: :!~-"/~'"/~ V ~7 ANCHORAGE, ALASKA MUNICIPALITY OF ANCHORAGE DEPARTMENT 0F HEALTH AND HU~N 'S~RVICES PO BOX 196650 ANCHORAGE, ALAS~ 99519 343-4~44 HAND WRITTEN PERMIT Permit Number: SW.900%%~ Permit Type: Design Engineer3 ~cF c.~,~w,, Day Phone: Owner Name: J~k Owner Address: ~Oo ~ ///~'~ '~/~ ~ Parcel ID: O/&~/~ Lot Legal: Subdivision: /~L~3'/OF ~3~ /~/~) LOt: /~ Block: Sect ~on:'.~ Towns h~./~ Range: Lot Size:~/~]F ~or acres) Max Bedrooms: This Permit: 3 Total Capacity: .~ SEPTIC TANK: Minimum septic tank csp~city: /~j~9 gallons. Each septic tank must have at least 2 compartments, ~nsulat%on is required if depth to top of septic tank(s) is less than 4..0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy o~ the well log must be sent to DHHS within 30 dsys of ~he well's completion. - ~z ..... ,/~ ~ ~,'~"~s< I CERTIFY THAT: 1. I will install the on-sAte sewer system mhd/Or well in accordance with all cod~s and regulations of ~he Municipality o~ Anchorage (MOA) and State of Alaska ~ and in compliance with the 'desig~ criteria O~ this permit. 2. I will mdhere to all MOA and State of Alaska requirements for separation distances from any exis~£n~ ~eli, ~eptic system, or surface water on thi~ or any adjacent or ~arby lot. 3. I understand that this permit is v~lld for a single family dwelling with a maximu~ of ~ bedrooms. I also understand that any anlargement will require an additional permit. fo= the calendar year 4- L understand this permit is and expi=e~ on December 31 of the year issued. 5. I will notify DHHS prior uo all inspeC%io~S by the engineer or well driller. SIGNED:_ (.owner/~desi~n~e),~~ ISSUED~~/'~/ ;'>''t ~ -'- / DATE: ~~9 DATE: __,~.'/~/~'O .db/ll5 RECEIVED t~3Unicipality of Anchorage Dept. Health & Human Services j'une 11, 1992 Municipality of Anchorage DHHS 825 L Street Anchorage, Alaska 99501 Attention: Robbie Robinson Regarding: Lot 15 Hillside Park PUD Subd. Dear Robbie, On May 12, 1992 we obtained a permit (#920080) to install a septic system on the subject lot. Since that time the property owner informed me that the permit application should have been for a 4 bedroom home. Please find the site plan enclosed which has been revised to allow the square footage, an additional 170 SF, for the 4 bedroom structure and please let me know if there is anything else required by me before installation by contacting me at 561-5829. Yours~,~ly, . L. Wayne McFadden 5 ..., x ,,XX'RECEIVED - ' i 'k k % JUN 2 ;5 1992 / f \ / 7~ ~ \ Municipahty otAnchorage \ \ ). Dept. Health & Human Services ~ . 'X. , '~dAL~. \ '~/' LOT 1~',.~. ~ , '"" "~'~' ~ -" ~t'~ '..*'¢ ~. t~'?.~ ............. : ~ LOT' 15 HILLSIDE PARK PUD ,y ,,^T,, ._.</Z?VZ =.,,., ,.-,'r ........... 0°,8 .Z~.,4R - '7~z~ ,~./ RECEIVED dUN 2 E 1902 Mun[d ~ ~ , ,. p,~h,y of A; cnorage DepL I-lealth & Human Services EN 18 (10/78l MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMANSERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: Date Issued:~/~ Design Engineer: ~£~ Owner Name: ~ Owner Address:~'~o Permit Type: Expiration Date: Day Phone: Parcel ID: ~ Lot Legal: Subdivision: /~z~c/~ /~ Section: ~ Townshi~./~ Lot Size:~/~ ~or acres) Max Bedrooms: This Permit: 3 Total Capacity:.~ SEPTIC TANK: Minimum septic tank capacity: /~ gallons. Each septic tank must have at least 2 compartments, insulation is required if depth ~o top of septic tank(s) is less than 4.0' Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. ~. ~I understand this permit is issued for the calendar year and expires on December 31 of the year issued. 5. I will notify DHHS prior to all inspections by the engineer or well driller. Zowne r/_~e s ~r/~ e-)/~. DATE: DATE: db/ll5 · . ' 'Municipality of Anchorafle IDEtSARTMENT OF H~LTH & HUMAN SERVICES 825 "L" St~t. Anchorage. Alaska 99502~650 SOILS LOG -- PERCOLATION TEST E~COUNTE~EO? 12 s DEPTH-:' P E _:i-KS DATE Sect on , SITE PLAN 13 14 15- 16 17 18 19 PERCOLATION PATE * + PROPOSED SYSTEM: BED (3 BDRM) (150 soil) (1.5) CONSTRUCT BED 18' x38 ' =684sq ft INSTALL 1000 GAL SEPTIC TANK ~A ?ROP0~EO %~oos~+ M.O.A. Approved. Insulate //xx~//~vc A~A if cover is less than 4 feet _ INSTALL GEO FABRIC OVER SEWER LOT ~ // ~ ROCK. Insulate bed if ///~/I"~\Jl I~ ~ i~0~O~LF, Bk0' cover is less than 3 feet. IF NECESSARY CONTRACTOR MAY INSTALL M.O.A. APPROVED LIFT STATION, UPON RECEIVING ALL CONSTRUCTION TO MEET M.O.A. SPECIFICATIONS DE T,/k I L5 .. ~%~ /~HD STYEOF~N ' ' q ' ~,, ~ HOD ~ pIPE NOTE: ~4 -- All Dimensions ~d LocatiOns Must Be Field Verified Prior To Construction SEWER SYSTEM 'LOCATION PLAN ..r.,,.,...F....,.p1.,x;;r.;;c.~,:~,, ' ......... ~.:,..:...:.,.~,_,,~,,~ ;.;x ................................ i ~ (( ,(/~ 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 Parcel I.D. # (~ 15~.~.~.5 & HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ~'/Z / ~,~'o~/<'Ez~ 7'-/-~E~.Z~/~· Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone J Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: individual well Community well 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 comm..uni,ty.o?site Public sewer NOTE: If community wastewater system, prowrde written confirmation from State ADEC attesting to the legality and status of system. 72-025 fRev. 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 witl~ all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Phone . -S¢/- I Date DHHS SIGNATURE ~' Approved for bedrooms. Disapproved.. Conditional approval for bedrooms, with the following stipulations: ~dd tional Co~\r~ents By: v ~ 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 engineeCs work. 72-025 (Rev. 1/91) Bac~ MOA~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Z /5 /-~//'/~/Z~E /~/J~K- P/JD Parcel I.D. A. WELL DATA Well type ~/YJ ~ D/J I T~f A, B, or C, attach ADEC letter. Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL LOG ADEC water system number Driller Casing height Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer Service line g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ?-/5'- 9 ~ Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping A/'~l~ Tank size / ~ ~-'-~ Compartments Foundation cleanout (Y/N) y Depression (Y/N) /t/,/'~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /Jo~tE. o~ To property line ~ ~ Surface water/drainage L. oT On adjacent lots Absorption field /~ -/- ,2.~ ~ Y- ,FOundation ~--~ Water main/service line 72,-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~_ /z/_ ~,~., Length 2, 0 Width ~ 0 Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating · (~ System type Gravel thickness J ' Total depth --~, Cleanouts present (Y/N) Date of adequacy test NE.t~ for '-/' bedrooms /L/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot NONE- O/u L.O-]- On adjacent lots ~C)©'-~ Propertyline To building foundation .5'~' To existing or abandoned system on lot On adjacent lots /~<~ '/- ' Cutbank ?~ ~ Water main/service line Surface water /L/'~F_ //d /mfn~'c~/.4 ~-~ Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 July 31, 1992 WALTER J. HICKEL, GOVERNOR (907) 349-7755 Mr. Wayne McFadden SUBJECT: Hillside Park (PUD) Class "A" Public Water System, PWSlD 212461 Dear Mr. McFadden: I have completed a review of this office's files concerning the status on the above- referenced Class "A" Public Water System and found following: Inorganic Chemical Contaminants: Date of last samples on record: Organic Chemical Contaminants: Date of last samples on record: Volatile Organic Chemicals (VOC's): Date of last sample on reCord: Radioactive Contaminants: Date of last sample on record: Total Coliform Bacteria: Date of last sample on record: Final Operation Certificate: Date Issued: Outstanding Violations: 18 AAC 80.200 7/02/90 18 AAC 80.200 11/12/91 18 AAC 80.400 11/12/91 18 AAC 80.200 10/12/88 18 AAC 80.200 7/06/92 Present in File 10/15/79 No > ~ prin~ed on recycled paper July 31, 1992 Page 2 Based on the above information, this Public Water System is in compliance with State Drinking Water Regulations (18 AAC 80). If you have any questions on the above comments, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II ML/pf