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HomeMy WebLinkAboutDEBORA BLK C LT 7I?4v= *045wo ONSC ol 000 MUNICIPALITY OF ANCHORAGE 1 �\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION " III ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME y1 PHONE/ ❑NEW 6-I•{�_-27% tRUPGRADE MAILING ADDRESS P. Q. f3vk 6-F 3 9s"67 LEGAL DESCRIPTION Lor %, LOCK G' l�Ef3oi2H SC%E• LOCATION �E nC DR, NO. OF BEDRO.03MS K � DISTANCE T0: Well /DO Absorption are / Dwellln , PERMIT NO. g 3 Y 7?0z WQ Manufacturer / n�F,2 C�/G Material G No. No. of compart�mLents Wf• Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth �� d Y DISTANCE TO: Well Dwelling PERMIT NO. J02 _ F Manufacturer Material Liquid capacity in gallons D a= DISTANCE T0: Well �Q0 Foundation — � Fi Nearest lot hn S PERMIT NO. d 2$ 7 3 J LL Z No. of lines Length of each line Total length of Ines Trench witlth Distance betwe n lines inches Top the to finish beneath Total H of gradeMaterial tile effecti a absorption area o z inches ,300 �4� • FT. Length Width Depth PERMIT NO. W t7 a F Wd Type of crib Crib diameter Crib depth Total effective absorption area UJ DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W 3 1 DISTANCE TO: IBuilding foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS/� Ql/ C • f c� 17-r 7-/ c , SOIL TEST RATING /00 �Q./ %. f3.Q, r INSTALLER / E2/ci<Son/ S %�j�cK/�oE REMARKS / /� — QENC CIS ED 0 4f 4 `r ,/MfZ7Ert/ T',QEA/C / 4,IEN6-7' ---fi CO'• r .0 .9 le �. Eorl B Ellis i •. NO. 1745-E •! ��� �CF�pBOFESS\ON f+ APPROVED DATE LEGAL ; �+ �[ac,C 7 3/ 79 Lor 7, �, ✓El3deH .Jur3. 72-013 (Rev. 3/78) 9:3 r•1 1_1t4 I r I Fr'^�iL I T be CO I= t rt FCH�?r:FIGE E9 r DEPARTMENT OF _ .iEALTH AND ENVIRONMENTAL F.. TECTIUtJ K L2J 4 .. 825 `L' STREET, ANCHORAGE, AK. 99501 ` 264-4720 CAt4—= I TE = EI•FEF? F=•ERr•1 I T PERMIT NO. C 790283 ) APPLICANT PAUL WATSON PO BOX 583-A CHUGIAK 694 2779 LOCATION MERCY DP. LEGAL L7 ELK C DEBORA S/D LOT SIZE 10275 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL EATING (SG! FT/BF:)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>EF•TH= 1c^. to L_EtJGTH= = 4 GF= FA%5E"L I-EF'TH= �t. t5 THE LENGTH DIMENSION IS THE LENGTH CIN 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 {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 CIN FEET). F EnCALJ I FZEL> 'SEPT I r` IFnr•JF_ •S 112: E: 2C=1C-10 C3nL_LCAr-4 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- IF L4 CA C 2 ] I tJ_ PECT I CAr•J•S nF?E F EiC!1_I I FZEL� --- 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 SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OF: 150 TO 200 FEET FROM A PUBLIC WELL DEFENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER IN'=TALLATION. F'EF -"t•1 I T EXF} I F?'E= T1s 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. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: A l.,f.,19_ APPLICANT PAUL WATSON ISSUED ---------DATE 1�_ r SDI AND WELLS AS SET ENLARGEMENT IF THE �D`J_S vy_ Uko ���p ,,�� 0 & E GEPTECHNICAL & DEVEnPMENT CO. Box 80, Davis St., Eagle River, Alaska 89577 6942774 or 688-2280 Rassed Oyster Ead Ellis 6942774 SOIL LOG M2280 Soils b Foundations Land Development Performed for: Name: PAy4 W47-501./ Tel. No. 675/-2779 Mailing Address: to O. 60x 58311,, 01106/1,1K, AK• 95.167 Legal Description: Z-07- 7 . el-OcK rC" DE8a2/9 �df30: Depth (feet) 0 1 2 ML 3 4 $oil Characteristics SR.VoY r .774 -41/$ Q 5 6 7 /l',L :&AloY 5-c7 7-1 e/B..e 12 �P 51Wz)1' aeaV61-, —13 Lra66cEs �!/ePFA9S /DO dJ/8.Q To /o "O, C4jr-="N 14 �tiEP DENJ�TY 15 16 /� yZ �OT TOM of /�iT ME�cY 1�,e�✓E PLoi PZWV No ScAGe Ground Water Encountered: Yes No ` If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: 1 -"CN LiA/E OtaAlA«O Fi�)2 ' L.edEL Performed by: 9&: 7/ - ; 1401�1 Date: WELL LOC Date Drilled: Static Water Level 62 feet Drax Down ,I. feet Tyre Material Drilled: 0 feet to 13 ft. clay Gallons Per Minute 12 Total Feet of Casing 76 11 ft. to 76 ft. gravel boulders to to to to Hefty Drilling IJ\� MUNICIPALITY OF ANON DEPT. OF HEALTH S S.R.A. Box 1553 H ENVIRONMENTAL PROTECTION Anchorage,Alaska MAR 2 i 1966 99507 RECEIVED I t 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 _;;hoI /X 1. GENERAL INFORMATION (a) Legal Desc jption (include lot, block, subdivision, section, township, Location (address or directions) (b) Applicant Ne am12 ��%i.t��.7 Telephone: Home Applicant Address — (70• A"2Zw (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer (d) -,Lending InstitutionZ//A-X-4ae =u42( Ifit Telephone Address (e) Real Estate Company and Agent Address Telephone (1) .AAeil the HAA to the following address: � LC ��� Bus ; Other ❑ (explain); 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms -Z 3. WATER SUPPLY Individual WetlX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the Slate Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsitePublic ❑ Community ❑ Holding Tank ❑ Note: If co munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025111,84) 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, l 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 _S$ j-Eng;newi Telephone Address Spa 196x °.Iver, elasks 99577 Date DHEP APPROVAL LD Approved for (LSU bedrooms by Approved Disapprove Terms of Conditional Approval Conditional a 191 11111f it 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-M (11/04) n n MUNICIPALITY OF ANCHORAGE (MON) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: A. WELL DATA MUNICIPALITY OF ANCHOttA DEPT. OF HEALTH 6 ENVIRONMENTAL PROTECTION MAR 17 ft] Well Classification �Q V �� If A, B, C. D.EC. Approved (Y/N) SIM Well Log PresentAm Date Completed &' ZS - gS Yield IS t N Total Depth yi(o' Cased to 7 L'r Depth of Grouting Static Water Level U Z Pump Set At Ii lK Casing Height Above Ground tZSanitary Seal on Casing ON) Electrical Wiring in Conduit 61 Depression Around Wellhead (roq Separation Distances from Well: Y To Septic/Holding Tank on Lot too f t ; On Adjoining Lots loo / To Nearest Edge of Absorption Field on Lot eco ; On Adjoining Lots To Nearest Public Sewer Line N�� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 3o r ~ Water Sample Collected by 4SL.rNDate Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 7-31-1711 Size 1Z50 No. of Compartments Z Standpipes &M Air -tight Caps 6,00 Foundation CleanoutrM Depression over Tank 4'f49 Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N/� ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank To Water -Supply Well 10o r To Building Foundation SS r To Property Line 10 1 To Disposal Field r7 yOr.� To Water Main/Service Line / To Stream, Pond, Lake, or Major Drainage N R Course Comments Page t of 2 72-02601184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata EGD �/iew— Type of System Design 7044 //JF/,EG p Date Installed 7-31- 7f Length of Field ZSR Width of Field Depth of Field 12, i Gravel Bed Thickness Square Feet of Absorption Area ��� Standpipes PresentcWHI Depression over Field (Ye Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well o z PP Y To Property Line To Building Foundation Lot To Water Maim Service Line n/, To Existing or Abandoned System on — : On Adjoining Lots 30 0 /L T C b k 'f fin' To Stream/Pond/Lake/or Major Drainage Course o ut an ( present) To Driveway, Parking Area, or Vehicle Storage Area Comments — D. LIFT STATION Date Installed . Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Levet at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •• 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. Signed S & S ENY28xing Date /57—V C s19fx S-S—vo 3 Company., _MOA No. Receipt No. Date of Payment —1-7—SSI Amount: $ <cJ!> Page 2 of 2 72026 (1I,84) Foj•'r En ebb � ti ►w, tu�� •4� � al •. •f�`rr �,hPR�cF4C\Fkr f �1 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562.2343 5633 B Street Anchorage, Alaska 99518 -�-•^~•• Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIERII TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.N Analysis shows this Water SAMPLE to be: (�X--PRIVATE WATER SYSTEM 5 1 S E.z 79 Name Phone No. City State Zip Code SAMPLE DATE: V.1-3 Mo. Day Year SAMPLE TYPE: •E�outine ❑ Check Sample (for routine sample 1 ,� Treated Water with lab ref. no. ❑ Special Purpose w Untreated Water SAMPLE Time Collected . LOCATION I L !/ (. ��>�a/l� d� I Calle B/`ii'4. 21 3 4 1 5 1 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE f -Satisfactory ❑ 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 � — IC2 — 4t, Time Received / e&O Analytical Method: Membrane Filter No. of coloniesl100 ml. Lab Ref. No. Result* Analys IeO21' m U m U m U m U m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB Final Membrane Filter Results Reported Bye TNTC = Too Numberous To Count Collforml100ml Coillormllooml Date Time: a.m. p.m. OB = Other Bacteria 3 �a l3 of0,,,.r dj. o^�t3I�e `f' o '(y A�'- woe M(2 -79 S. LEGAL DESCRIPTION --munrCIPALITY OF ANCHORAGE - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEION '�TAL 825 L Street • Anchorage, Atrka 99601 p STREET�LOJCATION .1llu, 5-�Q— lli 1• ENVIRONMENTAL ENGINEERING DIVISION E. T PE OF RESIDENCE Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be procured. Please allow ten 110) days for processing. 1. PROPERTY OWNER 1 Two ❑ Five PHONE MAILING ADDRESS 7. WATERS LV o p =oAj 9 PROPERTY RESIDENT lit different om above) PH NE ❑ PUBLIC UTILITY depth (attach log if available.) 9 - 22 2. BUYE ' "If individual/on•site,give installation date_ ❑ If system is over two (2) years old an adequacy test is required PUBLIC UTILITY, MAILIN ODRE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. r or ir 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS S. LEGAL DESCRIPTION - S STREET�LOJCATION lli 1• r E. T PE OF RESIDENCE MBE F BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other 1 Two ❑ Five ❑ MULTIPLE FAMILY /❑ Three ❑ Six 7. WATERS LV NDI VIDUAL' ��OFT, ' ATTACH WELL LOG. A well log is required for all wells drilled //❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ONSITE" - "If individual/on•site,give installation date_ ❑ If system is over two (2) years old an adequacy test is required PUBLIC UTILITY, by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 174 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME ,i TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: t. 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 ED PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED - INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING - - - TYPEOFTANK MANUFACTURER , TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest or Line Absorption Area to nearest Lot Line nn AA 5. COMMENTSlao" A�:Gt P4 K; ---APPROVED FOR �_ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ompany certificate) I-.7" DISAPPROVED A� DATE 1 BY IiTitint/) LEGAL DESCRIPTION 72-010 1Rev. 3/78) I CHUWAL a GEOLOGICAL LABORATORE8 OF ALASKA; INC. (907) 279-440E14 P.O. BOX 4.1276 ANCHORAGE, ALASKA 99509 4649 BUSINESS PARK BLVD. Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY PUBLIC W SYSTEM: LABORATORY: rWx►aC»v w 64NEwt bees NAME PublicWobr Sy Nrne �r y ,. ADDRESS M.IRrIp ,... A,tJeNI CITY .. CITY SAMPLE DATE: I NO Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. 1 LOCATION 1 /_-7 Kc i Collected �tw B 2 3 5 Date Received 6-7-79 Time Received 1e130_A4-.V Analytical Method: ❑ Fermentation Tube jX Membrane Filter Lab Ref. No., Result' Analyst CZ2 I � m m j m eMs el eebnMe1t00 eN.MNa NIeNlM pertlen� � 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1976 Date READ INSTRUCTIONS COLLECTING SAMPLE Form No. 18.310 (3.78) Source EMB Brat" 24 noun: BrNN 4e boursr Multlule Tube Report: 10ml Tubes PORtIW/Total lOml Portions Membrane Filter: Direct Count Collform/100m1 Verlfkatlom LTB BGB Final Membrane F C orm/100ml Reporteo Bit Dat P.M. �, � ------o �------------- -----. 1-�-. -- - -- S i --- ------ c� w� --- --- - - -------5�.9-�..� � �w"T ---- -- - --- - _ l _.._ __ _.