HomeMy WebLinkAboutSUMMIT ESTATES BLK 1 LT 2
NAME
MAILING ADDRESS
~--~ 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
[] UPGRADE
~o~ 7~ F ?550 ~,~
LEGAL DESCRIPTION
PERMIT NO.
No, of compartments
We Absorption area
Manufacturer
Manufact~mr
Dwelling
Material
Width
Material I 0 · ~'
Nearest lot Pine
Trench width
[ /C~ [~'~) I~a$inches
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT~)'~i~O ~ U]- ~
Distance between lines
Total effective absorption area
inches ~ ~O.¢f'
PERMIT NO.
Nearest lot line
Septic tank
Distance to lot line
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
Total effective absorption area
DATE
LEGAL
'%'/pjO ~3u~ -%o
72-013 (Rev. 3/78)
MU~ I C I PAL I TY OF;
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264'-4720
0~'--79-. I TE SIEW~-CR ~ ~ELL- PERM ~ T
PERMIT NO:
DATE ISSUED:
840572
07/15/84
APPLICANT:
ADDRESS:
CONTACT PHONE:
JERRY HELVEY
SRA BOX 71F 9650 BIRCH RD.
ANCHORAGE, AK 99505
546-3594
LEGAL DESCRIP: SUBDIVISION: SUMMIT ESTATE LOT: 2 BLOCK:
SECTION: 15 TOWNSHIP: I~N RANGE: 3W
LOT SIZE: 16200 (GQ.FT. OR ACRES)
MAX BEDROOMS:
Listed below are the options available 'Lo you in designing your septic
system. Choose the option that best Fits your site.
]'REI'~CH BED W- D~AI ~41
DEPTH TO PIPE BOTTOM (FT.
GRAVEL. DEPTH (FT.)
TSTAL DEPTH (FT.)
GRAVEL WIDTH (FT.)
GRAVEL LENGTH (FT.)
GRAVEL VOLUME (CU.YDS.~
TANK SIZE (GALS)
SOIL RATING (SQ~FT./BR)
4.0 4.5 4.0
2.5 0.5 1.5
6.5 5.0 5.5'
2.5 14.0 5.0
51.0 28.0 40.0
7.0 14.5 :L4.8
1,000.0 .~ 1~000.0 ~'~ 1~000.0
85 85 85
TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I certify that:
1. I am familiar with the requireme~qts for on-site-sewer.s and'~ells as set
Forth by the Municipality o£ Anchorage (MOA) and the State of Alaska.
2. I w.ill install the eystem in accordance with all MOA codes.and regulations,
and in compliance with the design criteria oF this per'mit.
5. I will adhere to all MOA and State of Alaska requirem~nGs FOr the-set back
distances From any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid ~or a maximum o£ 5 bedrooms an~l
any enlargement will require an additional permit.
IF A
THEN
WILL
ELECTRICAL WORK ~UST BE OGNE BY A LICENSED ELECTRICIAN.
si ED ......................... DATE:
APPL I CANT ~R~EL. VEY
ISSUED BY DATE:
LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
(1) .AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUlL. TS
NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264~,720
SOILS LOG - PERCOLATION TEST
'~'~O~LS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
3-
4-
5-
6-
8
9
10
11
12
13
14
15
16
17
18
19
DP'al
(t ?E -)
I.
/ ~,~r~ SLOPE SITE PLAN
WAS GROUND WATER ~ SL
ENCOUNTERED? O
,IF YES: AT WHAT
DEPTH?
Gross Net I Depth to Net
_ Rea.ding Date Time .Time Water Drop
.
TEST RUN B~TWEEN ~'~'~-~'AND. ~T .
STAT$~ OF A/~SKA
DEPltRT~NT OF NATURAPL ~ESO~C~S
LOCATION OF WELL
DOROUGH SUBDI~[I S ION LOT BLOCK SECTION QTR~ TOWNSHIP RAN'~ E M~RIDIAN
D=RECTION$: ·
Sgro~d su~fac~ ~other' Depth Of
BO~OL~ DATA. Depth STATIC WATER LEAL: ~(D ft Date~
Material typ~' an~-6olor Fr6m T0 '
,f.-./~ ~, METHOD OF DRILLING: ,~air rotary
Set Between and
G~VEL PACK
Volume used: -~'~. to top:
GROUT TYPE'~...... Volumu
Depth: from ......
DEVeLOPMeNT METHOD:
Duration:
Municip~i{i~y of Anchorage ~ ~ ft after / hfs pumping. ~.._.gpm
Dept. Healfh& Human Servi%s
PU~ ~TAKE DEPTH: ft Horsepower:
Date Pump ~ns~'~'d ................. ~ .........
CONT~CTOR IN~OR~ION: , WATER C~DMIS~Y 8~PLE TAKEN? ~ yes ~no
Reglst~ed Business Name
y// , //~.~% __ PLEASE MAIL WHITE COPY OF LOG WITHIN 45
DAYS
TO:
, - ... .-...'7- -,-~- ~ , , 'j ~,__.~1.-'~< ..... ..
Signature of Authorized R~resentative DGGS
D"'"' ~/ ~;~> PO BOX 77-2116
at~ " EAGLE RIVER~ AK. ~9577
Da'L ,::> ] ,:.. 71i ...'.,d: ()(i~/;:::'.? 190
COI'qSTRt. K:;I' F:)Ii:':F;: !ENG]:hI!iii:ER~[:~ At"t-AC:;HED ,"i!i:[TIE Pl..AN,,
UEL,L SHALL BE:. I..OCf~,TtED A M]:NIHt!M OF: :L()O F:EIET F:'RO["I ALL, SOLIRCIE!i~ OF
CON'I ~.~["t ] NAT I ON ,,
I'H :I ~i i::'[<I:RM :I: T IE XF:' I l::;:t!i:S :IP./:?!; :[/9() AND VAL I :iL) F::'OR A S :!: IqGL.E I:::'AM Z !.,Y HC)HIE ,,
i !:::[i],:'I ]:F:Y 'I'HA"[:
.I.,, :[ am .iam:J].~ar' ~,,!:i./:h tJ'l(.,:~ peqi.L:Ll'em(-;ff'vt:..nl fop c/rl.,.!~iite! s.~:?~¢apt5 ar',d ~,,~,:;,)l].~
fc)r'tl"i by 'Lh~,:~ I,'luriic:Lpa].i'Ly of Anchor'age (i"!OA) and the Sto. tf:~, of A]aska~
2. .!. ~:i.J,], :Ln~l,a:l.! '~he~ ~i:iys't:,c,~m in accor, d,tCtncc-;, v,~:i, th a].l MC)A cc:mh:.:s and
and ir~ cc)mp:l.:Lanc~ ~,,;:Lth 'Lh~,:~ des:i, qn c:r'itc~.:r'J.a of 'LhJ.~:i per, mi'L:,,
· ]:,:, :!: M:i.:I.] a(rlhc:,r'(~.: '('.c) a:~:J:t [ql]bi and St.a'k.(:.~ (::~' ALL~':~B!.::;~:~ ~',~.::,i::j~..~J.~-,~.>i~t~l~'l:.~ for' 'LH~:.: ~;(::~:. [::><:.~(:::1::
dJs'[anl::e,s fr'¢:im any (:~x:L~t:i.r'ig ~.h~:,].l:, ~.gas'J'..e~gatep d:(spQsat! ~sys'Lom of
:i, i,t,l'ldf'~j"~[~'~..~:~J"ld '~'r,J'l~).t thJ,~' per, niit :Ls valid f'cH", a maximum (::)f 0 I':)ech"(:.)oms.
S]!~;E) ~L[!d(:)p~EFLai]cJ LH.¢F~[:. '(..J'it((~ capac:L't.,y of Lhe 'Lo'La]. sy~t.(am :J,~:i ::5 l::)(Pdpc)om.~
. ........................ ..................
(,:]v-~...I ) (:':~I::.RALD h.b.,.vc.Y w ~ /
O0~F.~/
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 O F HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.#
1. GENERAL INFORMATION
Complete legal description
HAA# ~ (~°~ ~ C"~ ~ ?'~ n
Location (site address or directions)
Property 'owner ~r~l~ ~J~
Mailing address ~ ~/
Lendin~ agency ~R~/~L ~WK
Mailing address
Agent
Day phone
Day phone ~
Day phone.
Address
Unless otherwise requested, HAA will be held for pickup·
2. NUMBER OF BEDROOMS: ,~
3. 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.--,-
J
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.
o
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.
Name of Firm ~5'X''/-,z/ ~"~')-sc'/~L~2,'~;/'~ Phone ,~4~-~4~ 7
Address ,,~. /). ,~¢X //OZ¢/ l~ncZ~r~2g~ f~ ,.~,~//
Engineer's signature '
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
CE -~ 7604
bedrooms.·
bedrooms, with the following stipulations:
Additional Comments
By: .... / . .
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 DH HS 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-O25 (Rev. 1/ttl) Back MOA #21
' Mdnicipality _of. Anchorage : MENTAL SERVICE5 DiViSiON
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST UN ! 9 ]991
Legal Description: ,.5'/~/?~/Y)/~ ~L'~'~7~-~ ~DT~/./~/Parcel I.D. ~
A. WELL DATA
Well type ~ If A, B, or C, attach ADEC letter.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
ADEC water system number
Date completed ~ -,P-'~ - ,~4~) Driller .~.~,O/~,
/
,-~cO ' Cased to ~0~ Casing height
Wires properly protected (Y/N)
Date of test
Static water level
Well flow
FROM WELL LOG AT INSPECTION
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
· On ad acent lots /2~'
; On adjacent lots /.---~ '
Public sewer main
Public sewer service line
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Public sewer manhole/cleanout "
Petroleum tank -
Nitrate ~.. / Other bacteria -
Collected by: ~(.~ /.~ Cf . ,Z~/ .~/,7~,.~./.]~,
B. SEPTIC/HOLDING TANK DATA
Date installed ,Z~)5/TL/~ /°)"~4 Tank size ~~,~ Compartments
Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression (Y/N)
High water alarm (Y/N) ~ ~/~n~ ) Alarm tested (Y/N)
~ d
Date of pumping ~ ( ~U.~ ~ ~Ve~ ~ '~ ~i~C~'
l
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot /~' On adjacent lots ~O Foundation
To property line Z~' Absorptionfield Z~' (}.~: ~'?Watermain/sorviceline~Z'
Surface water/drainage ~oE~ ~/~z'~ /~'
72~)~6 (Rev. 3191) Front MOA 21
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DIS:FANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ,~,~ /.~,¢'
J
Length '~/,,¢' ' Width
Total absorption area '*.~.~) .~2°
Depression over field (Y/N) /~/
Results (pass/fail) /%//)
Peroxide treatment (past 12 months) (Y/N)
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
"~.¢,5~'/~rJr, q? System type
Soil rating
Gravel thickness Total depth
Cleanouts present' (Y/N)
Date of adequacy test .. ~.~
for N~ bedrooms
~ If yes, give date
To building foundation
On adjacent lots /,0,8 '
Surface water
Curtain drain
//~) ' On adjacent lots ,~-Z~ ' Property line
22. ' To existing or abandoned system on lot
Cutbank /'v/~m/? ca Water main/service line ~
.,.~-~ z4)/z~/~ 1~,0 / Driveway, parking/vehicle storage area
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.
Engineer's Nam6
Date t/~ ~/~ -,~/ u...l~
HAA Fee
Date of Payment
Receipt
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301
ANALYSIS REPORT BY SABLE for WORKo~dert 35318
Date Report P~intnd: JUN 18 91 @ 16:30
Client Sample ID:5721 E 97TH
PWSID :UA
Collected 3UN 17 91 t 11:40
Received JUN 17 91 ~ 12:10
Preserved with :AN REQUIRED
Client Name :HELVEY. GERALD A.
Client Acct :H~LVC, C
BPO ! PO $ NONE RECEIVED
Req S
Ordered By :GERALD A NELVEY
Analysis Completed :JUN 17 91 Send Repo~ts to:
Labozatory Supe~v!eo~, :STEPHEN C. ENE 1)HELVEY. GERALD A.
Chemlab Ref S: 912777 Lab Smpl ID: 1 Matrix: WATER
Allowable
Pazemete~ Tested Result Units Method Limits
NITRATE-N 2.1 mg/1 EPA 353.2 10
Sample ROUTINE SAI4PLE COLLECTED BY: GERALD NELVEY, WITNESSED BY DONNA HELVEY.
RemaYke:
Tests Pez£ozmed See Special Irmtzuetiorm Above UA-Unavailable
None Detected "See Sa]nple Remarks Above
Not Analyzed LT-LesH Than, GT-Greater Than
~,'~ SGS Member of the @GS Group (Socidtd GdnOrale de Surveillance)