HomeMy WebLinkAboutSNOW CREST VIEW LT 19rv� Lj�� LY (C
�oI(o- 1LI1- l'a
L
Development Services C)epartment
•-On-Sit e �, �'cter & .Wastewater Program
4700 8ragaw 5treet
�� P.Q. Bax 19bb50
Marls 3egich .ncyoroge, AR 99519-5550
Mayor !+n'+w muni.aryionSiie
(907)'_43-7904
Pump Installation Log
Well Drilling Permit Number: SW_
parcel Identification Number:_
Date of Issue:
Legal Description
property Owner Name & Address:
R-rj/-
Sn[ ®�!�✓ c R s r V i C&
®lHUo hi�C.C.iAlJ �A.vi-,
Pump Installation Date:
pump Intake Depth Below Top of Well Casing: %®
feet
pump Manufacturer's [dame:
pump Model: eAJS /0 GG
pump Size !. 6�hp
pitless Adapter Burial Depth: feet
pitless Adapter Manufacturer's Name: NriDl.J4*4-
pitless Adapter Installer:
'Neil Disipacted IIpan ;=omnleiiaa"as I
Medlcld t Ys ti
VA -.:2-
Comments:
Pump Installer Name:'
"o,
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump instadatiom-
�a ro GREA-,.cR ANCHORAGE AREA BOR'�,,._JGH
j,�VnJ�t Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAM
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELLC!!2
INSIDE LENGTH
TILE DRAIN FIELD:
C s
MAILING ADDRESS ✓ �'iY ` PHONE
LEGAL DESCRIPTION �G �� J/�l!_�l L c'J'%� ✓✓
/ NUMBER OF
MANUFACTURER ��< r MATERIAL[ -/: COMPARTMENTS
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS.
f TOTAL LENGTH_
DISTANCE FROM WELL/14C? FOUNDATION NEAREST LOT LINE // OF LINES �A
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH T( IN. TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE j
) DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_ IN. ABOVE TILE IN.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
DISTANCES:
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
INSTALLED
�r-
SEWER LINE DEPTH: J-1
PIPE MATERIAL:!
LOT SLOPE: l i od
REMARKS:
Form EQ -032
NEAREST SEPTIC
SEWER LINE , TANK_
REMARKS
DEPTH DISTANCE FROM:
SEEPAGE
SYSTEM_
DIAGRAM OF SYSTEM
DATE//_'/ O(APPROVED
i
TYPE OF SOIL HBSORBTlON SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS - 5 SOIL RHTING (SQ FT/BR)c 125
THE REQUIRED SIZE
OF THE
^ ���
�� ���������
Q TH F�x W 0 -1 W.
NET I-- ERE
BY 151 - U 1.1
DEPHRTMENT
' HEHLTH RND
ENVIRONMENTHL
STECTION
THE DEPTH OF
H TRENCH
OR PIT IS THE
DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND HND THE
BOTTOM
'
(IN FEET)
276~2221
-f-
WIDTH
'
&/u2hhw15
THE GRHVEL DEPTH
lly Ph 0~
50 1 IKE YET EE7
B"UH W! WO, 012
��
OF THE
PERMIT NO.
FEET)
1 I HM FHMILIHR WITH THE REQUIREMENTS FOR 00 -SITE
HPPLICHNTSRH
HND WELLS HS SET
FORTH BY THE MUNlCIPHLlTY OF
BOX 472Y
]44~6894
LOCHTIOH LILLIHN
LHNE
THE CODES
LEGHL L19
SNOWCREST SUBD
]� I UNDERSTRN HT THE 014 FATET
LOT
SIZE 8910
SQUHRE FEET
TYPE OF SOIL HBSORBTlON SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS - 5 SOIL RHTING (SQ FT/BR)c 125
THE REQUIRED SIZE
OF THE
SOIL RBSORPTION
SYSTEM IS�
Q TH F�x W 0 -1 W.
NET I-- ERE
BY 151 - U 1.1
1:1 M ERE L., TJ LET 1:1 - 1- 1-1 li-E':
THE LENGTH DIMENSION
IS THE LENGTH
(IN FEET) OF THE TRENCH OR DRHINFIEL).
THE DEPTH OF
H TRENCH
OR PIT IS THE
DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND HND THE
BOTTOM
OF THE EXCHVHTION
(IN FEET)
THERE IS NO SE[
WIDTH
FOR TRENCHES
INSTHLLHTION.
THE GRHVEL DEPTH
IS THE
MINIMUM DEPTH
OF GRRVEL BETWEEN THE GUTFHLL PIPE
HND THE BOTTOM
OF THE
EXCHVHTION (IN
FEET)
v? BEE top U X F&I ERE 01- KM10`015- I KI: -7- 1=1 Rho Ev YET 1: 10 uln — A- as al any �FIT �R.`K? R 4z n5,
1- Wo W K OR: :2 17 IM 05 10, oil wl� -1- :1 13 144 Ky,
��
PR::�: � E --Dl
BHCKFILLING OF HNY SYSTEM WITHOUT
FI19HL INSPECTION
HND HpPROYHL
BY THIS
DEPHRTMENT WILL BE SUBJECT TO
PROSECUTIONL
MINIMUM DISTHNCE BETWEEN H WELL
HND HNY ONPSITE
SEWHGE DISPOSAL
SYSTEM IS
100 FEET FOR H PRIYHTE WELL OR
200 FEET FOR H
PUBLIC WELL
SPECIFICHTIONS HND CONSTRUCTION
DIHGRHMS HRE HVHILHBLE
TO
INSURE PROPER
INSTHLLHTION.
Too LEE F&O WP X y- lot U. 3: Q Mil
FQ!: R E -E: ��TRrR:���
I CERTIFY THHT
1 I HM FHMILIHR WITH THE REQUIREMENTS FOR 00 -SITE
SEWERS
HND WELLS HS SET
FORTH BY THE MUNlCIPHLlTY OF
HNCHORHGE-
INSTHLL THE SYSTEM
IN HCCORDHNCE WITH
THE CODES
]� I UNDERSTRN HT THE 014 FATET
SEWER SYSTEM
MRY REQUIRE
ENLHRGEMENT IF THE
�
4J-11*,
�A�/
/�
^
�
�- ��� / � �- 7_
-- .
MUNICIPALITY OF ANCHORAGE
• -� Department of Health & Human Services M j
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # ��� l 4/f r'j HAA #
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
5�ic1C%'�J` ;Vi`
Location {address'ordirections)
(b) Property owner 'f�ks'� �a)' Telephone
Mailing Address
(c) Lending Institution
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone 34-5- 34�`'o
L w-5
(home)
Telephone
(e) Mail the HAA to the following address: (or check here if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family°K Number of bedrooms
3. WATER SUPPLY
Individual Well ❑ Community"q Public ❑
Business
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site`j�L_ Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 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
regulations in effect on the date of this inspection.
Name of Firm j / �S Telephone Z-79��'�j
Address /Y�✓ v.� jj %>�' ���'�
Date /�"� ✓�`�
144
•.
00,
00 • 09 fees** .10
a �
RC7f
RED, JR.;
0, CE -22 1
4 .•fav r
6. DHHS APPROVAL
Approved for bedrooms by--� /`�— Date
ApprovedDisapprovedConditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ! NCHO .AGF
ENVIi ONMENTAL SERVICES DIVISION
MUNICIPALITY OF ANCHORAGE (MOA) ..
Health Authority Approval (HAA) ' E�k3�
• CHECKLIST - FEBRUARY 1984
T 343-4744 r
Legal Description. �' WA ��-; eJe W�
set 6
A. WELL DATA
Well Classification
Log Present(Y/N)
Total I7t
Static Water
Date Completed
Cased to Depth of Grouting
Casing Height Above and
Electrical Wiring in Conduit
SEPARATION DISTANCES FROM
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
if A, B, C, D.E.C. ApprovedoYY N)
Yield
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Phi istc Sewer Cleanout/Manhole
; Date
Date Installed !/" °Size !4'00 No. of Compartments 71
StandpipesbN) Air -tight Cap (Y N) Foundation Cleanout 'S'% )
Depression over Tank (Y6) Date Last Pumped #-/-a lit
Pumping/Maintenance Contact on File (Y/N) ; for
Holding TankHgWater Alarm (Y/N) Temporary Holding Tank Permit (Y/N
)
'
SEPARATION DJSTANCES FROM SEPTIC/HOLDING TANK:
of
To Water -Supply Well ,
/ To Building Foundation y� 7i9�1'aP�i'yf ,
To Property Lirre, "�� I To Disposal Field
To Water Main/Service Line '
To Stream, Pond, Lake or,Major.Drainage Course
j1d
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C
e- / 9 51jaJG�'R&' T VIL14-,
ABSORPTION FIELD DATA 2 9�
Soils Rating in Absorption Strata u��" 1''� Type of System Design
Date Installed f/-Z2Z- Tr `
� Length of Field ��3
Width of Field 3 Depth of Field /0 �
Gravel Bed Thickness 6
Square Feet of Absortion Area 3�` Statndpipes Present(/)
Depression over Field (Y(N) Date of Last Adequacy Test
Results of Last Adequacy Test 1�baQuA7,L<
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well le)e �t To Property Line /
To Building Foundation To Existing or Abandoned System on
Lot �/f ; On Adjoining Lots /o "'t-
To
7`To Water Main/Service Line To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course Z" I_70—
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
d
SAmGal
"Pump On" Level at
High Water Alarm Level at
Tested for —
Meets MOA Electrical Codes (Y/N)
Comments
5'
Dimensions
Manhole/Access (Y/N)
"Check Permitted Bedroom Rating Against HAA Request"
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection, i
Signed 0 tk
�� °°•eeove �19
Company AV�Q°e •.;�' °�,
CIO
"i
Date .r' er's Seal
f �d / ..- v J�,
�oee• .�yee oee•eso.,
MOA No.
oe een.•. voc noa
® �n by e, fiEID, JR. ;S
4 °. CF - 2251 ri
G••V °fie
Receipt No. ��% - U%7 '�%S Sv Receipt No.
..:.-
Date of Payment _ 1� / Waiver Fee: $
Amount: $ Z70r OD Date of Payment
72-026 (Rev. 7/88) Rack Page 2 of 2
v
STEVE COWPER, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775
3601 C STREET, SUITE 1334
ANCHORAGE. ALASKA 99503
Alaska Environmental Control
Services
ATTN: Leroy C. Reid. PE, PhD
1412 West 33rd Avenue
Anchorage, AK 99503
DATE: October 27. 1988
PWSID: 210891
To Whom It Nay Concern:
According to the records on file in this office, the SNOWCREST
VIEW SUBDIVISION SOUTH Water System is in compliance with the
State of Alaska Drinking Water Regulations.
Sincerely.
i
Vera E. Craig
Environmental Field Officer
VEC:Pkk
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
DATE: November 10, 1988
TO: File
FROM: Daniel J. Roth, Civil Engineer, On -Site Services
SUBJECT: Confirmation of Waiver Approval Completed in November
22, 1976 for Lot 19 Snowcrest View Subdivision
This septic system was installed and approved by D.H.H.S.
approximately 5 feet from the front lot line. This lot line
fronts a 60 foot right-of-way and should not create a problem for
any surrounding lots.
This memo confirms the field waiver performed in 1976.
'
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
❑ One ❑ Four ❑ Other
SINGLE FAMILY
4
DATE
DATE
DATE
*ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY
- as-�
INSPECTOR
INSPECTOR
INSPECTOR\
PIC ealk�t
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
OF HEALTH ENVIRONMENTAL PROTE TLOJEPT. OF HEALTH &
�ONMENTAL
DEPARTMENT PROTECTION
825 LStreet - Anchorage, Alaska 99507 IfVVVV�K
•
OCT 2 0 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
R F (� F `, (�
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEM -M PR£�L1TW
DIRECTIONS: Complete all parts on page 1. Incomplete requests will.not be processed. Please allow ten (10) days for processing.
1. PROPERTYOWNER _.
PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
PHONE
2. BUYER
t✓W
MAILING ADDRESS
3. LENDING INSTITUTION _
PHONE
MAILING ADDRESS
4. REALTOR/AGENT n
PHONE
MAILING ADDRESS ,
5. LEGAL DESCRIPTION
•�j �S� Caw 5uk SOtt71
STREET LOCATION
CA (�
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
SINGLE FAMILY
❑ Two P Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATER SUPPLY
ED INDIVIDUAL*
*ATTACH WELL LOG. A well log is required for all wells drilled
0 COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
II INDIVIDUAL/ON-SITE**
17-26 YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
L' -V P I
THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
NOTE:
72-010 (Rev. 6/79)
V" I
C- THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL./ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size:_(�If Tank is homemade
give dimensions:
SOILS RATING
/ � S
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
11J� APPROVED FOR �� _ BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
)
BY
C1444k
72-010 (Rev. 6/79)
G�fw-�TER ANCHORAGE AREA BOROD6,�J
DEPARTMENT OF ENVI-RONMENTAL'!QU_ALITY _
3500 TUDOR ROAD -
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED: i
INSPECT: %i.Sl7
TIME:
�atj
M�e r REQUEST FOR APPROVAL OF
�P INDIVIDUAL SEWER WATER FACILITIES
p FOR
1 . APPROVAL REQUESTED BY:
ADDRESS :"
PHONE:
I f `( )�
;)7
: I ICfi E�
-3 553
/ice
2.
PROPERTY OWNER: 1?e'
TTi 6-,
/?)0,(C7fiI
PHONE:
3.
LEGAL DESCRIPTION:
f ICl
z 1r4,)
4.
TYPE FACILITY TO BE
INSPECTED: ' h `
STREET:
NUMBER OF BEDROOMS:
5.
WELL DATA:
.17 1,,-tla' Ace -,r/
A. TYPE /�/G L
f�Gc!�I r�Y /zv
B. DEPTH���f�9
C. SIZE
,�1 C/ SFS,j
D. CONSTRUCTION
E. BACTERIAL ANALYSIS
6.
SEWAGE DISPOSAL SYSTEM:
A. SEPTIC TANK (IF
HOMEMADE,
SHOW DIAGRAM
ON BACK)
I. SIZE
2. AGE /y5
3. MANUFACTURER
4. INSTALLER
•T APPROVAL REQUEST -FOR SEWER & WATER FACILIT,-
r' PAGE TWO
B. SEEPAGE PIT
1. SIZE
2. LINING
C. DISPOSAL FIELD
1. NUMBER OF LINES
2. TOTAL LENGTH
7. REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
APPROVED: DISAPPROVED:
DATE: DATE:
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
197'�
Pilcy P.Cal rstato
d L a,W-
r a fi
Vivii SubdiViSion.
a r Sirs,
r v th -
f -O r
nnnroval '!'
1,�) , s r
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a r s t z 19 -
S ho n n
tt ,Jill
f
SIOn"?-, bY thr
r of'
m a no vnr� r
0
`j
r if s
i T 1i i S
a r n t
aY Son 'aha t
t
t T strvi"I
'this IL't
3t t"
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y
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ti1v above
_y
)nj rou
-1t,:. t t t', office
sinc.nrely,
;.,mvironmental 57"�:cill' gt
St
cc: pecple,s �ank & Trost C0100any
Robert G. W(Abert