HomeMy WebLinkAboutPURINGTON 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/'