HomeMy WebLinkAboutSAND LAKE #2 BLK 1 LT 18X011- 13a- o-1
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' MUNICIPALITY OF ANCHORAGE
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
325 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
KEUQ KE; F&r,
E
MAILING ADDRESS
PO j30x f 9,�- PAle oras► E nK 91s/®
LEGAL DESCRIPTION
L r I _SA Aj o L AN 2 * 1 g W See
/C5
LOCATION
NO. OF BEDROOMS
6N0ICQ'h i ST:
2—
U
DISTANCE 0:
Well !
1®i
Absorption are
4
Dwelling
Mor'05co
PERMIT NO.
Q4 -o 9v)
Q
Manufacturer
Material
No.
No. of compartments
Lic. capacity in gallons
i
IF HOMEMADE:
Inside length
Width
Liquid depth
Q
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J02
Manufacturer
Material
Liquid capacity in gallons
®
LIJ g
DISTANCE TO:
Well f
aJ % 1
Foun anon
P' C�i°06�J•�
Nearest lot line 1
/3
PER IT NO. tX:
�-C' %eq
J u-
z
No. of lines
1
Length of ea h line
Total leng h of lines
Trench wi h
Distance between lines
W
➢ °
119. S
inches
Allm
4 rc
cc
Top of the to finish grade e
�.1
`i'
Material beneath the e t
Total fe rive aida bs tion area
®
P inches
Length
Width
Depth
PERM O.
W
al--
w�
Type of crib
Crib diameter
Crib depth
Total effective absorption area
Lu
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
w
W
Class
OE'Ic6 A'T
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tan) i
Absorption freal)
OTHER
PIPE MATERIALS
i..
D30-3
SOIL TEST RATING
INSTALLER
G-
7
REMARKS
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to
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APPROVED DATE LEGAL
' �
M UPJ -1 C:� E -3 F f--; E: E '
^ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, At,,. 9q501
264~4720
.
^ �
C3 0�4—E-i; E3, E,- W EEA::;� �EK"L- L- ���R" M | -1" �
^
PERMIT N 840789
DATE ISSUED: 09/17/84 `
APPLICANT: KEVIN KEIFER
ADDRESS: P"Q"BOX 695
ANCHORAGE, AK 99510
LEGAL DESCRIP: SUBDIVISION: SAND LAKE #2M
LDT: 18
BLDCK: 1
SECTION: 10 TOWNSHIP: 12N
RANGE: 4W
LOT SIZE: 8000 <SQ.FT, OR ACRES)
MAX BEDROOMS: 2 `
'
Listed below are the options available to you in
designing your
~
septic
system. Choose the option that best "its your site.
P` R~U Ta, FE r� vs~
DEPTH TO PIPE BOTTOM (FT.) 4.0
4"0
4.0
GRAVEL DEPTH (FT. ) 8.0
0.5
3"5
TOTAL DEPTH (FT.) 12.0
4.5
7.5
GRAVEL WIDTH (FT.) 2.5
15.O
5"0
GRAVEL LENGTH (FT.) 19,0
30.0
33.0
GRAVEL VOLUME (CU. YDS. 15.0
16"7
24.5
TANK SIZE (GALS) 1,000"0 ** 1,0O0"0
** 1,000.0
**
SOIL RATING (SQ.FT./BR) � 150
150
150
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
.... ... --- --- _�_�___....
..
"
�...... ~__~_
I certify that.,.
"
1. I am familiar with the requirements for on-site
sewers and
wells asse-,-
forth by the Municipality of Anchorage (MOA)
and the State
of* Alaska"
2. I will install the system in accordance with
all MOA codes
and regulations,
and in compliance with the design criteria. of'
this permit.
3" I will adhere to all MOA and State of Alaska
requirementssr
for
-.1t
the st 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 For a
maximum of 2
bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A'LICENSED ELECTRICIAN.
SIGNED
DATE:
APPLICANT: KEVIN Y7. ME
ISSUED BY
DATE:
SOILS'LOG
MUNICIPALITY OF ANCHORAGE
• ae DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 PERCOLATION
825 L. Street, Anchorage, Alaska 99501 264-4720 TEST
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: A6.SY-a ZnjgstrfeS DATE PERFORMED: Sept 10 �K 8
LEGAL DESCRIPTION: S&0 Lo (Ce �4 2— Lot 18 'ry 7 --
SLOPE SITE PLAN
()t, Ur10.n1L Sa, I(
2 s.'� dean 5"j
3
4
5 `.
6
7
8-
9
10-
11 -
12
13
14
15 "•
16
17
18
19
20
COMMENTS
rkr, II-
Spmf Jajeri r.ur"c S7 LJ
sofvQ- I ate, ers -N e d
Via1all1 ra{ci e
WAS GROUND WATER
ENCOUNTERED? IVa
IF YES, AT WHAT
DEPTH?
MEN
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
0
ENO
11 z 54.
0
ME
0
ME
110
INN�����
Rea
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
11 z 54.
VA -T 1)u
PERCOLATION RATE
TEST RUN BETWEEN FT AND
,n y/PERFORMED BY:_&� rq N0,1 S`T 0Ke'Z-df CERTIFIED BY:
`V 72-008 (6/79)
_(minutes/inch)
FT
D rl ' I6
ALASKA 6WIROI1m MAL CONROL HIffS, InC.
Cnyncermq & Enuironmenlal $ludlcs
December 21, 1984
Department of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99501
Subject: On -Site Sewage Disposal and/or Well Inspection
Report
During 1984, a number of septic systems have been installed and
inspected, prior to the establishment of the foundation(s). AECS has
contacted (or attempted to contact) the applicants concerning the
installation of foundation clean-out and pipe from the foundation to
the septic tank inlet. In many cases, construction will not resume
till in the spring; therefore, precluding any further inspections.
Since the end of the year is near, with the expiration of permits,
AECS is forwarding the inspection reports without a foundation
cleanouts to your office. We understand that this will not eliminate
this situation; nonetheless, the reports reflect the actual inspected
installation at this time. We recommend you accept these as is. The
Health Authority, site evaluation for these properties can confirm the
installation of the cleanout. Conditional approval, based on required®�
installation in the spring, may be required during the interim. / `D
If this office can be of further assistance, please contact us at
561-5040.
Sincerely,
J
L. D. Montgomery
Supervisor,
Environmental Department
Approved By:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HE:,' -T : 9
ENVIRONMENTAL PROTECTION
DEC 26 RM
RECE1',-'LD
120^ II.'-" 33rd Awnue Sude B • An nnroe? Aitisko 99'i()1-19071 %1-5040
WELL LOG
Date Drilleds 9_11_80
Static Water Level 105 feet
Draw Down__ N/A feet
Tyne Material Drilleds
0 feet to 95 Silty Sand
95 ft. to 97 Black Sand
97 ft. to 113 silty brown sand
113 ft. to
200 Sand
200 ft. to 215 Clay
' 18
Blk 1
Sand Lake Subd.
Gallons Per Minute 30
Total Feet of 0asing 221
215 ft. to 221 Gravel, sand, w/water
Hefty Drilling
S.R.A. Box 1553 H
Anchorage, Alaska:
99507
MUNICIPALITY OF ANCHORAG2
DEPT. Of HEALim 8,
ENVIRONMENTAL PROTECTION
VOV 2
RECEIVED
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES M} i
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. # _fit l - f '�n - M HAA # 4 �O� It 0\
1. GENERAL INFORMATION
Complete legal description Lot 18, Block 1, Sand Lake #2
Location (site address or directions) 8108 Endicott Dr.
Property owner FT1-IC-_ Mikta Saewc Day phone
Mailing address 4300 Boniface Parkway, Anchorage, Ak. 99507
Lending agency Day phone
Mailing address
Agent _
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
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.
R
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 furtherverify 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 - -,
Phone
Y :7. ( t
Address Y 7
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
bedrooms.
Date /—/�-,�I
•- s A- �3y -
� i�yJ n oa aeo�'9�a
i �Qa.- ssn ^.aus�¢'cv• sq�a�a�n
'+• a as a..0 iee ee •4a .�
n Aoberf A. Shafer
No. I457-2
auOJ�
bedrooms, with the following stipulations:
By: a7__ Date 4-1& —C/-/
—
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 orderto 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 k21
Municipality of Anchorage
Department of Health & Human Services F "
HEALTH AUTHORITY APPROVAL CHECKLIS�/k'
Tql 5.�.
Legal Description:/, � ,Aii: A-5-11 -J:k2 Parcel I. D. A/o
'rf
A. WELL DATA Rep.(o/
�199I
Well type'Simr, "r")& If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Q/N) U Date completed ! - (1 - e'q Driller
/ t
Total depth Z Z Cased to Z f Casing height / Z t t
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level
Wires properly protected (Y/N)
FROM WELL LOG
(off
3a g.p.m.
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
98r
+ g.p.m.
V (�
Septic/holding tank on lot ( f- ; On adjacent lots ( DO r+
Absorption field on lot ! I I ; On adjacent lots ( 00
Public sewer main IC) /1— Public sewer manhole/cleanout �1A
Public sewer service line N 11 R Petroleum tank to /A
WATER SAMPLE RESULTS: W P
Coliform 6At -&fAe_ e Nitrate ��4 ti Sr �ofT Other bacteria O
Date of sample: 3 - ( Collected by: t tjr- (-rr�_
B. SEPTIC/HOLDING TANK DATA
Date installed �1 - Z to - 934 Tank size / Z 's -C) Compartments 2
Cleanouts (Y/N) Foundation cleanout (Y/N) T— Depression (Y/N) /J
High water alarm (Y/N) tj 1A Alarm tested (Y/N. )J (A
Date of pumping I _Z__ 9 I
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
f / r
Well(s) on lot I e I On adjacent lots ( dO t Foundation +
r r /
To property line ( n f Absorption field 1 Water main/service line ( d
Surface water/drainage IDD 4
72-026 (Rev. 3/91) Front MOA 21 - CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed sN
Size in gall0.ns'., '
'Pump "level at
High u4ter((a''l
Meets 9 . cttriical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
—Manufacturer-
Manhole/Access
ManufacturerManhole/Access (Y/N)
"Pump off" level at
Cycles tested
Surface water
Date installed - 2 �o TJ�i Soil rating _ t System type ! ;ie
Date
LengthI q , �_ Width Gravel thickness Total depth f
Total absorption area i Z Cleanouts present (Y/N)
Depression over field (Y/N) d% Date of adequacy test
Results (pass/fail) for .1_> bedrooms
Peroxide treatment (past 12 months) (Y/N) 6-2/A If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 j I On adjacent lots Z ® f Property line / 3
To building foundation / co To existing or abandoned system on lot
r , ,
On adjacent lots_ --;z,n f Cutbank SO "t Water main/service line (O
Surface water bo �f Driveway, parking/vehicle storage area /0" -/-
Curtain
0/fCurtain drain n5 + t4pvSe l S Vlot ecgNt. Sy S ht M fe - %004
toU- f-0 to sV A�5
E. ENGINEER'S CERTIFICATION f
l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
HAA Fee $/ /7J
Date of Payment
Receipt Number 075z)
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ _
Date of Payment
Receipt Number
Signature
S:iV'7,—IM;
Engineer's NamA'L ar3 River Loop Road N® ea
P(
Eagle giver Alask 99577
Date / `�
4
A,it'
�L y�• cYirnrr . 5W(34,e t;�,
HAA Fee $/ /7J
Date of Payment
Receipt Number 075z)
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $ _
Date of Payment
Receipt Number
r 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 (I 2-5 6's
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
<SAte)� PKC tBL-OL<} LcT 19 'TI?NP3W SFr- to
Location (address or directions)
FAD l_ Co Tr iy fv A fZ %O'rl+
(b) Applicant Name (� E V I FW K'= I FI� E 2 Telephone: Home 336 3384 Business Z 4 3
Applicant Address F° 160Y b q S Nc1{ � Vis 10
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ;Other ❑ (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address _
Telephone
(f) Mail the HAA to the following address:
P
2. TYPE OF RESIDE CE
Single -Family Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Telephone
Individual Well Community E3Public ❑
Note: If commuunity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite w Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11184)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND 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 all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm D1 G `--3 Telephone
Address 1 7-0 C) W j J a� /� r,,� C o c, 2 A G E
Date t
0j, Ht ,. 1. •., .
u 0480//90' .,0000002 '�
s EVg
A
o. 2251-E
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'/ C oO ee a60a¢�d` V ii'9l
(� pRQFESS1flC�`
6. DHEP APPROVAL
Approved for � � bedrooms bye e
�/ n��ate
Approved fa4A Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates 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)
MUNICIPAUTY OF ANCHORAGE
DIFF. OF HEALTH &
INVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) NOV 2 7 10,
CHECKLIST - FEBRUARY 1984 �7VJ
264-4720 R
Legal Description: SA n1a LA 1` E T` � � 1< � DCOT 18
-t'IzN P,3w SE -C 10
A. WELL DATA
Well Classification do,%esiSc If A, B, C, D.E.C. Approved (Y/N)
Well Log PresentYY ) Date Completed ` - I I' B4 Yield -30
Total Depth 2Z1 Cased to zZl Depth of Grouting
Static Water Level 105 Pump Set At
Casing Height Above Ground Sanitary Seal on Casing(()�N)
Electrical Wiring in Conduit ®/N) Depression Around Wellhead (Y/61
Separation Distances from Well:
To Septic/Holding Tank on Lot I ; On Adjoining Lots C T 1 0 0
To Nearest Edge of Absorption Field on Lot I 1 ; On Adjoining Lots GT 100
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot i
Water Sample Collected by ��' /�� ; Date -2-1
Water Sample Test Results
Comments
B.
B. SEPTIC/HOLDING TANK DATA
Date Installed Z 6464 Size 1-2-50
Standpipes 671N) Air -tight Caps�G�V)
Depression over Tank (Y.?
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 10 1,
To Property Line 23
To Water Main/Service Line GT j
Course 61 1 � 00
No. of Compartments a
Foundation Cleanouto/N)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
2-
To Building Foundation So
To Disposal Field 14 -
To
4 -
To Stream, Pond, Lake, or Major Drainage
Comments (` iw—
. OCu� iem Iv✓J "t71a.� 6�-2 2-v
Page 1 of 2
72-026(11/84)
� A 01> (- A r- C- 'A Z f3 ��ck r ZoT ig
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ISO
Date Installed Z6 / 84 -
Width of Field 3
Square Feet of Absorption Area 3 I Z
Depression over Field (Y/0
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well I l \
To Building Foundation O
Lot ^'
r
To Water Main/Service Line �T- /O
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in �alt s
"Pump On" Level
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Type of System Design ( KE N c f I
Length of Field Ig(- j
Depth of Field 1 2 -
Gravel
Gravel Bed Thickness i
Standpipes Present
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
On Adjoining Lots 2-5 B U1-wE E N S Tg NDP 1 I'E_S
To Cutbank (if present)
,T
to
GIT S
Dimensions
Manhole/Access (Y/N)
— 'Pump Off' Level at
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signe 4 ����f"�—. Date f1�Zi --8
Company 2�tC-' lute MOA No. _57— 5 _2- /V- °a� OF `t 'W
Receipt No. '� (O U I � 9f-"'01, 0•` } °pY oW
Date of Payment I I 'c� ] : ��.TE Y"a��Q
`^ e
i�9 Yfp
Amount: $ Y ne"Ws0 °ea
q• Y�
�o ��� ineer%5r
Page 2 of 2
72-026 (11/84)
YC. Reid,
Na. 2251-E
OQU�$A9YCl�H
0FESS\�