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HomeMy WebLinkAboutDEBORA BLK A LT 4�l-tL�t(. 50 03S 38 000 \ ('� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street . Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW !� L DTlj r ❑UPGRADE MAILING ADDRESS Slf Zcb 3 — 14Nc K, LEGAL DESCRIPTION Lo LOCATION NO. OF BEDROOMS 3 s -a a DISTANCE TO: Well / Absorpuonaea/. Dwelling PERMIT �L�i..,��/ jj D �� —Y i Za Manufacturer /_ �� C7 Mater'al _ ` No, of compartments.? WF a Liq�a �ci in gallons IF HOMEMADE: Inside length Width Liquid depth — b Y DISTANCE TO: Well welling PERMIT NO. _?�0z Manufacturer _ Material Liquid capacity in gallons DISTANCE TO: Well } Foundation Nearest lone. /� PERMI Q = s S,5/ Z No. of lines Length of sac / Total length o / Trench wi Distance between lines IYIlIl f, W Inches H Top of the to finish grade Material beneath the Total effec a absor on area inches Length Width De PERMIT NO. W l7 a F Type of crib Crib diameter r eplh Total effective absorption area Wd w DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. W i DISTANCE ui di u t n Sewer line Septic tank Absorption area(s) OTHER Q PIPE MATERIALS SOI LTES RATING L r Do NSTALLER REMARKS /v Tb S c A �. Retort A. Shafer• w ,. 1457-E c� i6Vin; "••• .��. r ..•.'� APPHOV DATE LEGAL U ILA 6.?7 /�_ d ? 1Trr,�LE.PtVEFllat�rs�t, 72-013pey(3/76) 77. by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 89567 • TELEPHONE 6882759 t i/ OWNER OF LAND rF_,eX r f �t rU�+ ^� DEPTH OF WELL a ADDRESS 4/ / 7'QZ nd'4 SJ)?E a203 .7 STATIC LEVEL OFWATER FT. LEGAL DESCRIPTIO^? L tjtK pr o� o C/4 DATE -Started Ended PERMIT NUMBER .. -. _. .... _ _ t KIND OF FORMATION: , FromFt. to S2 Ft. V6 le 15u'eA05iJ FromFt. to � Ft. From �� Ft.to�'Ft. C«4� 1�rRJ5L� From -) I Ft. toT-5--F[. 14-J10 16ep-/ From4,1 Ft. to—Lr--'-Ft. S9'y� From—f—d, Ft.to�_FL X -4,t40 6'p4'j'=4 From Ft. to Ft. I uJA%-0- From—Ft. t FromFt. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to "' —Ft. From Ft. to Ft. Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. MISCL. INFORMATION: DRAW DOWN FT GALS. PER HR KIND OF CASING From Ft. to Ft. MUNKIPAUTY OF ANCHORAGE From Pf. lin+ 6 Ft. —DEFT- ENVIRONMEt -FRUT-rcnON From Ft. to Ft. Mei 2 01'985 From Ft From —REV.EM1I`.-Y ER From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From' Ft. to Ft. From Ft. to Ft. From Fl. to Ft. From Ft. to Ft. From Ft. to Ft 1 Y DRILLER'S NAVE rvura I C Z F}r�� = 1`•,r O� r�rJ��HL-1I2FiC3E DEPARTr1EDir OF HEALTH AND ENVIROW)GArAL-PROTECTION e25 'L' STREET. ANCHORAGE, AK. 99501 264-4720 WELL_ �ilJR �3rJ--SITE SGL•1Eti;C f"EFcM I T PERNtT no. < 830583 ) APPLICANT-LnKOTA CORP. 5401 CORDOVA SUITE 203 551-3fiZ LOCfiTION LEGAL LOT 4 SIX A OESORA SUB LOT SIZE 999999 5oURRE F TYPE 9F'SOIL ABSORPTION SYSTEII IS: TRENCH .MAXIr1UM NUMBER OF BEDROOMS 3 SOIL RATING <SO FTIBR)a 140 THE REQUIRED SIZE OF THE SOIL ASSORPTfON SYSTEM IS: i?EF='-rtA= O Lf=- N(3TH— --R::B t3f:;a= VE[_ OEPTH— 4 THE LENGTH DIMENSION THE -DEPTH OF A TRENCH GR13UND AND THE BOTTOM THERE IS ILO SET' W fOTH THE ORAVEL DEPTH IS TI AND THE BOTTOM OF THE IS THC LENGTH CIN FE£T) OF THE TRENCH OR DRAINFIELO. OR PIT IS THE DISTArAE BETWEEN THE SURFACE OF THE ; OF THE -EXCAVATION <IN FEET). FOR . TRENCHES. 4E MINIMUM DEPTH OF GRAVEL BEfIJEE.N THE OUTFALL PIPE, EXCAVATION CIN FEET). f; e_,a3%u I F2EQ SEE fF 'TIC TFa1VK. S 12E= :JL000 13F4L_I_or%' PERMIT APPLICANT HAS THE RESPOW19tLITY TO INFORM THIS DEPARTMENT DURING TW INSTALLATION INSPECTIONS OF limy [JELLS ►10,Immir -TU THIS PROPERTY AND THE tvirisER OF RF5tDEt4lXS THAT THE WELL WILL SERYL --- 'T'WO. <ZZ? f E:IM XI EZC> BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION AND APPROVAL BY THIS i DEPARTMENT WILL BE SUBJECT TO PROSECUTION. IININUi DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM 15 ioa FEET FOR A PRIVATE WELL OR 159 TO 200 FEET FROM A PUBLIC WELL DEPEFIOIWi I UPON THE TYPE OF PUBLIC WELL- MINIMUM ELLMINIMUM DISTANCE FROM fl:PRIVATE WELL TO A-PRIYATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOOS ARE REQUIRED AND rtUST BE RETURNED TO THE DEPARTMENT•turmtri 30 c^15 OF THE WELL COMPLETION. OTIIER REQUIREI-JE14TS 19tly APPLY. SPECIFICATIONS AND CONSTRUCTION 0M.IR1105 ARE -AVAILAAL.E TO INSURE PROPER INSTALLATION. f_'I=F'51j I T e3: I CERTIFY THAT 1: I AM FAMILIAR t-111`11 THE REQUIREMENTS FOR ON-SITE SEWERS AND WEL-L5 AS SET r` FORTH BY THE. MUNICIPALITY OF ANCHORAGE. 2: 1 WILL IPI5TALL THE SYSTEM IN ACCORDANCE 14IT14 THE CODES. .3: f UNDER S THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THET RESIDENCE EMOOELEO 0 If:pXUDE MORE THAN 3 BEDROO6IS. GtGNED.-_- _1�C± -__.- _ _ --- --� 1 AP L C 1: KOTA CGRP. tt�_ i ISSUED BY _ .�: �' ---DATE D ! _LL V4.� MUt-J I C I F1: it I TY (DF= F=lt4CHpF;ZFiGE DEPARTMENT G. HEALTH AND ENVIRONMENTAL 1 )TECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 W ELL SEL•FEFZ F= EFZI- 1 I T PERMIT NO. C 830580 ) APPLICANT LAKOTA COPP. 5401 CORDOVA SUITE 203 561-1026 LOCATION LEGAL LOT 4 ELK A DEBORA SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT1BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: l>EPTH= O LEt4GTH= 2�O GFRFiVEL [>EF= TH= 4 THE LENGTH DIMENSION IS THE LENGTH (IFJ FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN 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 CIFJ FEET). F_F=ip I F[EI7 SEF='T I C Tt=�t iFC SIZE= 1 �E+U C��iLLOtI� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY I -JELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL I -JILL SERVE. --- TWO C 2 7 I t4SF= ECT I k3NS; AF<E F-:EG!U I FRE© --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BET14EEN A WELL AND ANY ON-SITE SEWAGE 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. F='EF:;:Il I T EXF1 I FtES DPECEt'10EFi: s1 s I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEI4ER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPL LAKOTA CORP. 1E;l:E-s AND WELLS AS SET ENLARGEMENT IF THE ISSUED BYX ----_---DATE�j,�,l LL V4. 0 •. r r MUNICIPALITY OF ANCHORAGE r„ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DEPTH (FEET) O 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 PERFORMED 72-008 (6/79) 7i—/Z C724V6-L. Ee OF A(AItlr N0. T17f-E . a 40" 22,1968 R_ SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: 6-2-3—J02 GROUNDWAS WATER S■■■■NEEM■■ IF YES, AT WHAT E IN ®r,, '0401 MIKE DEPTH? I-ENEEMENNEW ReadingDate Gross Time Net Time Depth to Water Net Drop �OkAL fr, .PERCOLATION RATE (minutes/inch) -' TEST RUN BETWEEN FT AND FT RTIFIED 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 �S 1. GENERAL INFORMATION (a) Legal C (include lot, block, subdivision, section, township, raj e A 1-21eW01C/V C_ Location (address or directions) (b) Applicant Namd.L Applicant Address (c) Applicant is(deck j�j n (d) Lending Institution Telephone: —J� Business Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; OtherA (explain); Telephone Address (e) Real Estate Company and Agent Address Tpl phone (f) WtH he HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family❑ Other Number of Bedrooms 3. WATER SUPPLY Individual We� Community ❑ Public ❑ Note: It community wel I system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteA 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 72025(11,8+i 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 verifythat 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. l 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 I Address Date 6Ybert h Sbefor No. MI -E 6. DHEP APPROVAL Approved for - bedrooms byate Approved Disapproved Conditional Terms of Conditio al Approval I jj 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 ANCiCRAG:! 1 DEPT. OF HEALTH G j MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) ' °; i u 0 L0051CHECKLIST - FEBRUARY 1980 J 4720 CEIVED Legal Descri tion: L �� ,5EBa,c,4 C/A A. WELL DATA Well Classification �2 t� NT F If A, B. C, D.E.C. Approved (Y/N) Well Log Log Present Date Completed ) 13 -83 Yield � L �r �• `� �' Total Depth 541'01" Cased to L/O 1 v Depth of Grouting Static Water Level ("a 4 It Pump Set At. f �' Casing Height Above Ground �� r�r Sanitary Seal on Casingep# _ Electrical Wiring in Conduit 64#)' Depression Around Wellhead /Q Separation Distances from Well: To Septic/Holding Tank on Lot gi r :On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer _ r Cleanout/Manhole e 1�-' 14- To Nearest Sewer Service Line on Lot `» Water Sample Collected by 4sz S �^�tK«='tty ;Date C'7"83 Water Sample Test Results S'A 7 /S FAQ Comments k 1 f/E.e 04 7-7—,4C /-1E,o� B. SEPTIC/HOLDING TANK DATA Date Installed o 3-9-S Size (C p9 No. of Compartments a Standpipes J5�Jdj Air -tight Caps (x; Foundation Cleanout6#I417 Depression over Tanv*,,& Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ^•r 14'-' ; for A-! Holding Tank High -Water Alarm (Y/N) N IA— Temporary Holding Tank Permit (Y/N) �'- Separation Distances from Septic/Holding Tank; L I To Water -Supply Well y % To Building Foundation S To Property Line �� r- To Disposal Field Sr~ i r To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11,84) -. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �d d �j0� Type of System Design /✓C�NLr Date Installed g�3 �$3 Length of Field 3B r Width of Field 3o Depth of Field 6 7 Ji Gravel Bed Thickness Square Feet of Absorption Area 3Oacl� Standpipes Present Depression over Field Pfi W Date of Last Adequacy Test Results of Last Adequacy Test a/a Separation Distance from Absorption Field: / To Water -Supply Well 'r 11 To Property Line To Building Foundation /S Lot /`/ /A- ;On Adjoining Lots _ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. D. LIFT STATION /O f 't - To To Existing or Abandoned System on 307 To Cutbank (if present) A- Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at I "Dump Off' Level at High Water Alarm Level at e I Vent (Y/N) Tested for _ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments Check Permitted Bedroom Rating Against HAA Request " 1 certify thajy WV #WS@dpffad, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. SRB 196X Signed-, ALASKA. ZZS77 Date R Company PH. 694-2372 4% ' Receipt No. 3_110820 `�'� % I % Date of Payment Amount: $ 6� A. Mg%f • j 4 @'•, Ho. 1457-E 1 ml ••, 1�.*1$A Page 2 of 2 +fitAFD n: -:-:-%LN i 72-026 (11,84) A HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 5622343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I-) See h on back I.D. NO. t G% - g2 watar Svstem Name Phone No. c$�/�.t� i yG •e' 1 Mad?Ador.0 /' City State SAMPLE DATE: Mo8 s. Day Year 2p Code SAMPLE TYPE: �ROUtlne D Check Sample (for routine sample t O with lab ret. Treated Water O Special Purposea :2 -Untreated Water SAMPLE NO. LOCATION /S/y I 4 I 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Time Collected Collected TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: gsattsfactory ❑ Unsatisfactory ❑ Sample too 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 S Time Received /,S-00 Analytical Method: O Fermentation Tube Membrane Filter Lab Ref. No. Result' Analyst ED I I m u m .ro acown../tooM e.No 0F0.1.. 0a, 1220 m1 BACTERIOLOGICAL WATER ANALYSIS RECORD A.,19113 Membrane Filter. Direct Count Verilleatlon: LTB Final Membrane Filter Res is Reported By TNTC= Too Numerous To Count Collforml100m1 Collforml100ml Time: g77 a.m. p.m. STATE OF ALASKA ^ BILL SHEFFIELD, GOVERNOR DEPT. OF E.NVIRONMF.NTAIXONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 May 17, 1985 Mr. Robert A. Shafer, P.E. S&S Engineering SRB 196X Eagle River, Alaska 99577 274-2533 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 4, Block A, Debora Subdivision, Eagle River, Alaska (8521 -WA -161) Dear Sir: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 97 feet on the subject property for a 3 bedroom single family residence only. Sincerely, ZZ Steven W. Eng, PP District Engineer SWE/msm