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HomeMy WebLinkAboutDEBORA BLK A LT 5j��,G� Sic ���<<�r�. it 050 ops 37 C)oc) ~1I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION III I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264x3720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE vEW „„ /-r ❑ UPGRADE MAILING ADDRESS 5'I0I ut cK LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ELE—L�IJO . DISTANCE TO: Well/ i Absorption area p t Dwelling PERMITjV,D u 0 D3 S _Y s Q Manufacturer Mate 'ar' 1 No. of compartments W a Liq.cap cit gallons IF HOMEMADE: Inside length Width Liquid daptk--- 6 Y DISTANCE TO: Well Dw ❑' PERMIT NO. JV2 S? H Manufacturer _ Material Liquid capacity in gallons DISTANCE TO: Well % ,� Foundation Nearest lot licks PERMIT O = D 1 Z P W Q No. of lines Length of each line / Total length of line/ Z Trench width has Distance between lines H Top of rile to finish grade / Material beneath lilaTotal effective bsorpt� area 14 7 inchesr" Length Width Depth PERMIT NO. W (7 d h Wd Type of crib Crib diameter I fCrib depth Total effective absorption area , DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J 3 DISTANCE TO: Bui ding foundation Sewer line Septic tank Absorption steals) OTHER s o PIPE MATERIALS SOILTEST RAT�I INSTALLER ' LAI REMARKS r L- , T • f n A (:.burl A Ho. Ld57-E y�•••.........•'`.P�. �LpRCF[`S\Ca p ft5 • l , _ APP VE qATE LEGAL SFBLAS 72-OY IRev. 3/78) a Tr &�i ir' b l3 rjiltng tog by DOC Co. aba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 OWNER OF LAND / EK C Y f t • ✓A..t DEPTH OF WELL ADDRESS 461 eQA9d0(J0+- n,1TE LEGAL DESCRIPTION L 13°r«r O«•.aR DATE -Started -77Ll r�,F-7 Ended PERMIT NUMBER KIND OF FORMATION: From Ft. to Ft. to'Z Ft. D04CoC4u0Ca4F From `2 Ft. to-iLILFt. From r 1 S09 .O r C4A✓E t . From Ft. to �3 Ft. .�Aw 0 From q 3 Ft.to.9ZFt. 6l4,Jcc a Ft. to From From i Ft. to Ft. Ft. to From Ft. to Ft. ..... .rte '. From Ft. to Ft. From Ft. to Ft. e 1 From Ft. to Ft From From Ft. to Ft. From i Ft. to From Ft. to Ft. From `Ft. to Ft, Ft ..... .rte '. From Ft. to Ft.— t. Ft From From—Ft. Ft. to + Ft. Ft. e 1 From Ft. to Ft. Ft. From From Ft. to--_L—Ft. gItr6.2 G a STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER IIR .7400 KIND OF CASING G 4L 0 { i i i From I Ft. to From Ft. I From Ft. From Ft. to Ft From � Ft. to Ft From Ft. t� Ft. From r Ft. to Ft. From Ft. to FL From i Ft. to Ft. r From Ft. From Ft. From - Ft. r From . Ft. From Ft. From 1 Ft. From 1 Ft. _ From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLERS NAME DEPARTPIENT'OF H AL7H AND ENVIRONMENTAL F'RfQUCTION 82C, 'L' CEI, ANCHORAGE, SK, 55 264-4720 •* WELL tat4O Otd---IEZ I TE SEWER PEFCt`t I T RMIT NO. C EzH.75 > ;ICA147 LAKOTA CORP. 5401-CORDOVA-SUI7E 203 S61-1021 T7 ON L LOT 5 ELK A DEHRA SUE: LOT SIZE 55555y SQUARE FEET OF SOIL ADSORPTION SYSTEM IS: TRENCH nUif NIIMUR OF BEDROOMS = Z SOIL RATING CS!? FT/BR>a 100 tE61UIREG SI2E OF THE :OIL ADSORPTION SYSTEM IS: :F�TNa 7_E3 LENl3-r -ta 25 ORHVERL 41C LENO7H"DIMENSION IS THE LENGTH CIN FEET> OF THE TRENCH OR DRAINFIELD. ffE DEF'TH OF A TRENCH OR PIT IS THE DISTANCE EETNEEN THE SURFACE OF THE 40UND HND THE E:O77OM OF THE EXCAVATION CIN FEET). ,IERE IS NO SET WIDTH°FOR TRENCHES. iM GRAVEL DEPTH IS THE HINIHUM"GEPTH'OF GRAVEL EETWEEN THE OUTFALL PIPE ID THE 6077011 OF THE EXCAVATION.CIN FEET). r�t_� I fi ELS SEF='T I C-rnt,(tc ja nL-L-C t.l5 17 fiFf'LICANT HAS THE. REf-PONSIE+ILITY-TO INFORM THIS DEPARTMENT DURING THE 1LAT10N INSF-EC7I014S OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE iR OF RESIDENCES THAT THE 61ELL WILL SERVE. TWG C 7 I t+iST= ECT I L�tJS f�!~cE REGItJ I REt7 ----- ;1LL.ING-OF ANY SYSTEM WITHOUT FINAL INSPEC71ON-AND APPROVAL EY 'THIS TMENT WILL' BE SUBJECT TO PROSECUTION. lUM DISTANCE E;ETNEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL ,Yr-TEPI 75 EET FOR A PRIVATE NELL OR ISO TO 200 FEET FROM A PUEUC WELL DEPENDING THE TYPE OF PLIU I C WELL. IUM DISTAIICE FROM A PRIVATE 14ELL 70 A PRIVATE SEWER LINE IS 25 FEET AND CQMMLINITY SEWER LINE IS 75 FEET. JOGS ARE RENUIRED AND MUST PE RETURNED TO THE GEPARTMENT1111HIN-30 DAYS WELL COMPLE710N. ;'REPUIREMENTS MAY APPLY. SPECIFICATION5 AND CONSTRUCTION"DIAGRAMS ARE AL'LE TO JHSLW.E PROPER INS76LLATION. :j�;I't I T UECEMt=iEFC ailLo :1 S)13� fIFY THAT iM.FANILIAR WITH THE kEAUIRENENTS FOR ON-SITE SEWERS AND WELLS AS SET ".BY THE tILINICIPALITY OF ANCHORAGE. TILL INSTALL THE S%`STEM IN ACCORDANCE N17H THE CODES INDERSTAND THAT THE ON -SI F SEWER SYSTEPf MAY REP.UIRE ENLARGEMENT IF THE NCE 75 ODELED IN DE ORE THAN 3 BEDROO1,L& AF'f JCH(g7� L KUTA CORP. ✓ _/? V4.O DEPARTMENT .HEALTH AND ENVIRONMENTAL TECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WELL At -JE> C3t4—'S ITE SEGJER F=ERt'1 I T PERMIT NO. < 830579 ) APPLICANT LAKOTA CORP. 5401 CORDOVA SUITE 203 561-1026 LOCATION LEGAL LOT 5 ELK A DEBRA SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEFlTH= 1ID LE"C!-F"= Z�v 13FZn VE L_ E>EF�TH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION! (IN FEET). REGlU I REQ SEF= T I C TF=l t4K S I ZE= dL CA ID C, GFiLL_CDNI PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- —F—WO <.: ] F=lFRE RFZ DU I REC7 --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SE14AGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FJEFRIl I T E:XF} I RES ©ECEME3ER 31s 15+£ 3 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE 14ITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED ISSUED V4. 0 • . r^ • � SOILS LOG MUNICIPALITY OF ANCHORAGE ❑ PERCOLATION i DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L Street, Anchorage, Alaska 99501 2640720 \~ SOILS LOG - PERCOLATION TEST PERFORMED FOR: I V O M1 CAC1r' CO NST(_ DATE PERFORMED: 1 Z LEGAL DESCRIPTION: L 5 6 A DC -130 r A 5'I% DEPTH SILTY 'S' N� (oe' SLOPE SITE PLAN 1 : 0- 2- 3 3 D:p 4- 5- 6 5 6 ^� 7- 8 8- _. 9 :Q1 O -• 10 1J-� - 12 13 j -Z?;14. 15- .16- 17- 18- 19- 20L 5•1s171a1s20 COMMENTS GAVEL 15ANp 85 jillgo_ 5F#DJ�9 fi;�Fi✓C�- �9i� GDTII)m OF H o L.E o� '• 1 i�P •�J Ruben A. No. IIA PERFORMED BY:_r?"._ 72-008 (6/79) iF�aWi WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop I PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN T AND FT n 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 5 Block A Debora Subdivision Location (address or directions) (b) Applicant Name Virginia Kohfield Telephone: Home 694-9183 Business 694-4200 Applicant Address Re/Max of EAgle River (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution First Interstate BAnk Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family EkxMulti-Family ❑ Other Number of Bedrooms three(3) 3. WATER SUPPLY Individual Well Qxx Community ❑ Public ❑ Note: II community well system, must have written confirmation from the Stale Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Qr 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 n-025(11184) ("141 n 5. ENGINEERING FIRM PROVIDINv INSPECTIONS, TESTS, FILE SEARCH, DAIH 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 sale, 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 tiles 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 o1 this inspection. Name o1 Firm Address Date Telephone Engineer's Seal 6. DHEP APPROVAL Approved for three(3) bedrooms _ Date Masry 14, 1985 Approved xxxxx Disapproved Conditional Terms of Conditional Approval This is a retype from the MOA, Health and Human Services Department files. The original Certificate apparently has been lost. 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 engineers work. Page 2 of 2 72-025111,04) n 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 1,6- /102 1,21'/�S'C�/'!-� ✓ �LJ Location (address or directions) (b) Applicant Name _ c ! Telephone: Home 4 = Business6;E— Applicant Address (c) Applicant is (chef) Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other (explain); Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familyb�-Multi-Family ❑ Other _ Number of Bedrooms L� 3. WATER SUPPLY Individual Wvlk.,,Community ❑ Public ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onstl< 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 721025111,8+) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION a 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 SL Address ..SLE F Date Telephone No. 1657-E 6. DHEP APPROV� Approved for bedrooms by ate Approved Disapprov 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 - MUNICIPALITY OF ANCHORAGE (MOA) MUNCPAIM OF ANCHORAGE DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRON41EPRAL PROTECTION CHECKLIST - FEBRUARY 1984 284-4720 MAY 13�85� Legal DesccAc1ppli�on: L T c� 1J��Q2.r d A. WELL DATA Well Classification tyorTLN Irl - If A. B, C, D.E.C. Approved (Y/N) Well Log Present /tiY Date Completed 0)�.>S '$7 Yield 15tC ofos O• S (op'" - Total Depth ![(-r Cased to qOit Depth of Grouting Static Water Level (V21 Pump Set At L-lOC— Casing Height Above Ground /� rr k- Sanitary Seal on Casing,264W Electrical Wiring in Conduiolg< Depression Around Wellhead4414 Separation Distances from Well: To Septic/Holding Tank on Lot /o o / ; On Adjoining Lots /0.0 ' To Nearest Edge of Absorption Field on Lot /O o ; On Adjoining Lots /001 To Nearest Public Sewer Line N y'� To Nearest Public Sewer .r Cleanout/Manhole N�f To Nearest Sewer Service Line on Lot Water Sample Collected by SLS �"" r^�tra'N6 ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 9'3-83 Size ( C op No. of Compartments ZL Standpipes 194W) Air -tight Caps 6/.W�-Foundation Cleanout iOibW Depression over Tank4Y4 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) �'+��� ; for Holding Tank High -Water Alarm (Y/N) T Temporary Holding Tank Permit (Y/N) /V/ - Separation Distances from Septic/Holding Tank: To Water -Supply �� pp y Well ° To Building Foundation To Property Line /J N To Disposal Field S/ To Water Main/Service Line S`s To Stream, Pond, Lake, or Major Drainage Course N Comments Page 1 of 2 72-026111/841 v C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Irz"O_ f Date Installed JS r Length of Field Width of Field KI h— Depth of Field 101 Gravel Bed Thickness & Square Feet of Absorption Area 3�o91Standpipes Present &fq Depression over Field Date of Last Adequacy Test Results of Last Adequacy Test N j A - Separation Distance from Absorption Field: To Water -Supply Well OOH To Property Line To Building Foundation I S t ~ To Existing or Abandoned System on 3�1 r ct ~ Lot ; On Adjoining Lots 3 r To Water Main/Service Line S'a To Cutbank (if present) 'a To Stream/Pond/Lake/or Major Drainage Course N/'¢ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) Check Permitted Bedroom Rating Against HAA Request " Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked. verified, or conformed to all MOA andH Aguidelinesineffect onthe date ofthis inspection. Signed r' '^^ -�„ '^ Date ✓r sr,D 3 Company r �,.AO 101r^ •+ T, /kgOA No. S'H 694-2370 � Receipt No. 2, Date of Payment — , Amount: $ W( •00 Page 2 of 2 72.026 (11,84) =� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. f TELEPHONE (907) 562- 343 ANCHORAGE INDUSTRIAL CENTER 5633 8 Street — Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: (-) See It on back I.D. NO. Water System Name Phor s No. c�1 _6 I Msihrw Address GM State Zip Code SAMPLE DATE: tw�v �ry��}�--%—�'� L=am Mo. ` DIy year SAMPLE TYPE: LlRoutlne ❑ Check Sample (for routine sample D Treated Water with lab ref. t treated Water [3 Special Purposee SAMPLE Time Collected NO. LOCATION Collected y lL o s ZA Ae,A_ 13L 2 S 4 5I READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: t'Sausfactory ❑ Unsatisfactory ❑ Sample loo long in transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result' Analyst 099-101 l I m l •I m I I m I I m •pe 110Cebrr•6/100" 0," aft weo.roro W220 (•) BACTERIOLOGICAL WATER ANALYSIS RECORD A..1983 Membrane Fitter. Direct Count Verification: LTB BOB Colllorm/100ml Final Membrane FI r Results v ColiformI100ml Reported By L Date S !" G S Time: �l UnD a.m. P.M. TNTC= Too Numerous To Count 119rlf\ �' A EXCAVATION ROBERT A. SHAFER WORK CIVIL ENGINEER 694-2979 March 6, 1983 MUNICIPALITY OF ANCHORAGE ['EPT. OF W P.L TH 7, ENVIRO\MYNTAL PBJTECTION Terry Sullivan MAR 10 Ion; 2520 East Tudor Road Suite 3 RECEIVED Anchorage, Alaska 99507 Dear Mr. Sullivan, Reference:. Lot 5; Block A; Debra Subdivision A field visit to Lot 5, Block A, Debra subdivision and an examination of the soils log recorded for this property indicates that the soil in the area is capable of treating the waste water from the septic system adequately to allow a horizontal separation between the waste water treatment facility and the water supply (well) of 120 lineal feet in lieu of the prescribed 150 lineal feet required for a multiple family dwelling. It is our opinion that the combination of the actions in the septic tank and the processes acting on the waste water as it passes through the soil found during the soil test should produce a water of acceptable quality for discharge into the ground water under proper conditions and at the recommended distance of 120 feet. Based upon this opinion we recommend that the Municipality grant a waiver to you to allow a horizontal separation of well and septic of 120 feet. If we may be of A. SHWER, P.E. ss service, please do not hesitate to call. cc: Municipality of Anchorage Department of Health and Environmental Protection SRS 196X EAGLE RIVER, ALASKA