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HomeMy WebLinkAboutSAMPSON ESTATES BLK 2 LT 6r �w r � �. ,, �� 7 \. 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 NAME PHONE yy ❑UPGRADE MAILING ADeSS _ 004 LEGAL DESCRIP ION �s Trf LOCATION NO. OF BEDROOMS DISTANCE f0: Well Absorption �re� T Dwe gAj PER Np L Y a Q LU I- Manufacturer /��. f1 1 F--=� Matce�rial J No, of compa tments , 7 N Liq. rapacity in gallons ` IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well . ` Dwelling PERMIT NO. Sz FQ- Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well Foundation .� Nearest to I"ne /� PE IT 0 L. j = l p ! .^� _ L Z H w No. of lines - / Length of ne) Total length - li sj 4 Trench widt Q inches Distance b tween lines - FTop of tile to finish grade Material beneath tile- Total effe've absor area / 11 inches 3� Length Width D th PERMIT NO. _ Lu ` 0 4C F Type of crib Crib diameter depth Total effectivJ absorption area LJ wWell U3 Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to to line PERMIT NO. J -s Lu � DISTANCE TO: Building foundation Sewer line Septic t nk Absorption area(s) OTHER C. p PIPE MATERIALS L 'r Y SOIL TEST RATING � L_ INSTALLER 5c-~ js, 1 REMARKS 1'! J o s� ��:.••0 •AAL '00-Sr�� 1� .•«• .. Mbort A. thAff . + i •.e Mc. 1177-E L �F APPROVED �.�ti143��4'�16��t-� DATE EG 72-013 (Rev. 3/78) . " - / / L- - C / ' PERMIT NO: DATE ISSUED:' APPLICANT: ADDRESS - CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS-. M U P4 I C; I Fn'gc-'� R I -r"�r C3F=f�NPIC:::PFAC3FRe-NCDIE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~8� 825 L STREET, ANCHORAGE» AK 99501 ^= 264-4720 "M -~E3][ -K -F_= fSFE'WEEF;C ��F=F7ZM][~T^ 840539 07/03/84 SCHMIDT BROS. EXC. C/O S&S ENGINEERING EAGLE RIVER., AK 99577 694-2979 SUBDIVISION: SAMPSON SECTION: 3 TOWNSHIP: 15N 40907 (SQ.FT. OR ACRES) 3 LOT- 8 BLOCK: 2 RANGE: 1W Listed below are the options available to ** you in desigminQ.ymur septic' system. Choose the 'option that best fits your site. ^F_0 -:z e7U%4cl� 1�_l F�c E7.n K°j D3F:z 44][K^4 ' DEPTH TO PIPE BOTTOM (FT.) 4.0 4^0 4.0 GRAVEL DEPTH (FTJ 5.0 0.5 3.5 TOTAL DEPTH (FT.) . 9.0 4^5 7.5 GRAVEL WIDTH (FT.) 2.5 23.0 5,0 GRAVEL LENGTH (F.) "r3"0 44.0 79.m ** � GRAVEL VOLUME (CU"YDS.) 37"1 37"4 58"5 TANK SIZE (GALS) 1,�00.0** 1,00O.O e* 1�000.0 ** � .,.SOIL RATING (SQ.FT`/BR) � � 243 224 '243 � GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOTEXCEEDING 75 FT. EACH) ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ~-~,~- - -~.- - _-_~^__~_.~_- _-.~_--_~�_�__-^��~__~ I certify that: 1. 1 am familiar with the requirements for on-site sewers and wells asset forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install thesystem.,in accordance with all MOA codes and regulation's, � and in compliance with the design criteria of this permit" 3. I will adhere to all'MOA and State of Alaska requirements 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 for a maximum of bedrooms and any enlargement will require an Additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MDA BUILDING CODES, THEM (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE -.OBTAINED- (2). AS-8UIK'TS WILL NOT BE APPROVED WITHOUT AM ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICALWORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPLICANT: ISSUED BY - DATE: SCnMEXC",14-f DATE: ___________ � i ❑ SOI LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: -- ,I'"I- I � I –C S&^ DATE PERFORMED: G LEGAL DESCRIPTION: ��% 1` lCJ Z? Z--1� — PS�_)� eS r—� SLOPE SITE PLAN - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 046 PcN lc— (�� rcl�f ear= I tm-e 72-008 (6/79)i 4(�g� 41 ,.• "•. . r ( r . • �,',3'1'd tde, T �37� .•• a`"r�A ti MEMO ■■1i■ ■■1,■ ■■��■ MEMO ■tM■ ■NINE ■NI■■ ■ff1■■ ■11■■ MEMO WAS GROUND WATER NJD S ENCOUNTERED? L O p P IF YES, AT WHAT E - DEPTH? Reading PERCOLATION Date Gross Time Net "rime Depth to Water Net Drop J Z Z ' Zv P tv-1 is N /� o /2- 112- PERCOLATION RATE TEST RUN BETWEEN �3 (minutes/inch) S_ FT AND FT MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal 8 iptio3a (include lot, bloc Location address or directions) (b) Applicants Application Date subdivision, section, township, range) > 6v3 Telephone - Home Busi N e7l�-7 Applicants Address Z/U L.- / 0 ����C/ 7< L� (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer E:j ; Other F�:j (explain); (d) Lending Institution /"-) L' /�-ji Telephone Address (e) Real Estate Co. & Agent G AV le- .Xflr/a� Ty AddressX/Z- Telephone �744 -7 / ' /? C �� (f) Ma3­lthe HAA to the following address: SRR •S J:ii T. I'x�}14e1n YC� ➢ �:L Ali YYin 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Individual Well Multi -Family Other (describe) Community Public El Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite 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 I of 2] 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 regula- tions in effect on the date of this inspection. Name of Firm Address u P133t na re+max-rn�>,.^.. -• � ('.W li �gq� Telephone Date �'�ie4-2LJ7 /y`C; 1". 1-Y!fid �, s • � (ENGINEER SEAL) 6. DHEP Approval Approved for bedrooms Approved —>(— Disapproved Terms of Conditional Approval z> � Ret+eN A. .A�P%e° No. ids% -E i Cneve ,eeee`��.5+ By 4 Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/DI8 [Page 2 of 2] 7-19-84 A. LI �Y �I��IVI/tiGIV1 T.6 .... .Iai� MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) Nov CHECKLIST - FEBRUARY 1984 1_0�"g V Wr L EIiTA Well Classificatio If A, B. or C, D.E.C. Appro d(YL Well Log Present (Ym _ Date Completed Yield' 6� Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/WM Tank on Lot 2C�L� ; On Adjoining Lots 2-CND l l 71- To Nearest Edge of Absorption Field on Lot 2<tl � � On Adjoining Lots 000 To Nearest Pabiie-Sewer Line To Nearest Public Sewer 1 ,1L � Cleanout/Manhole A td - To Nearest Sewer Service Line on Lot h Water Sample Collected By 3 4 � �h ���itj Date Water Sample TestjRoults/P 29-9-/ Ccnuents B. SEPTIC/HOLDING TANK DATA Date Install d �Z Size _ Standpipes (Y Air -tight Depression ver Tank ( ) Date Pumping/Maintenance Contract on File 0 No. of Conpartments 2 40Foundation Cleanou (Y C) .iii NP tc-1 for Holding Tank High -Water Alarm (Y/NV Temporary Holding Tank Permit (Y F�- Separation Distances from Septic/Holding Tank: To Water -Supply Wall 07L_-�O C - /_ To Building Foundation To Property Line /© C� To Disposal Field cfi To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course /__J 0 AJ /` Comments Aj- o u IF 30 �� -6 iI 4 [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 7(3 Type of System Design lig u% Date Installed 7 Length of Field 7-3 Width of Field �' Depth of Field T Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present Y C) Depression over Field (r, p Date of Last Adequacy Test CL-' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Wall�0, (iL To Property Line la ( k To Building Foundation To Existing or Abandoned System on Lot, /_J -0 �� C On Adjoining Lots /L'o ` /- To To WaterglaiTr/Service Line r-) �� To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course /(-J 0 A_JL t To Driveway, Parking Area, or Vehicle Storage Area cj Comments f`' c N D. LIFT STATION Date Installed Dimensions Size in Gallons /Maa cess /N "Pump On" Level at Gj I o u Level(Yat) High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed r Date RIVECompany �&), MOA No. KB1/d5/s (Page 2 of 21 2-15-84 STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVALTO CONSTRUCT Plans for the construction or modification of, f,� 0 YO F -c f r3T(.5 y % b TS 1' 7S 1A I- F6- D 1 of A,� I public water system located ,Q in Q f f `e Alaska, submitted in accordance with 18 AAC 80.100 by have been reviewed and are approved. ❑ conditionally approved (see attached conditions). BY � TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. S. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) MUM&R&V 8Y ANCHORAGE Date DEPT. OF HEALTH & ENV IRnIuN FNTAIPROM-TION C. APPROVAL; TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public.�`-{� 0 The construction of the�� Vo" t�-6�7 ( public water system. was completed on �0 ` (date). The system is hereby granted interim approval to operate for 90 days followin6 the completion date. BY TITLE - DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was construc)ed according to the approved plans. The system is hereby granted final approval to o ate, p BY TrrLE DAT 1 DISTRIBUTION: 1. WHITE- ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEERIMUNI-BOROUGH (Complete Section C) 18-0407 (Rev. 11183) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A)