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Home My WebLink AboutDEBORA #2 BLK D LT 14Lor Z 0:0 050 0+( 0¢ oco \\ 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 NAMEPHO"N�E A ONEW MAIL16,tRESS X957-7 LEGAL DESCRIPTION G /J- LOCATIONNO. OF BEDROOMS DISTANCE TO: Well/oc I J AbsorPto alea Dwelling / PER IT j NOS ,S L O Y 2 W F Manufacturer�j 7C — Material �— No. of compartments a Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth fj Y DISTANCE TO: Well Dwelling PERMIT NO. Diaz _ 4 Manufacturer Material Liquid capacity in gallons O DISTANCE TO: Well ' �j d Foundatio s Nearest 1 �Qe P H 11T N � W= L y� f,'0A' J � 2 No. of li Len th of ach hl e7 r Total lengt of lines Trench width Distance between lines F-? W $ / inches •� Top finish Material beneath rile Total Fes- of the to grade effectivea sorption area o d W `Caj inches Length Width Depth PERMIT NO. W U Q t– Type of crib Crib diameter Crib depth Totel effective absorption area W� in Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE T0: Building foundation Sewer line Septic tank Absorption areals) OTHER E PIP TERIALS oro �/E s3 O S SOIL TEST RATING 8IS INSTALLE L flEM 1L 49 7Q - 6-0-r- [r"J45_ !�d O , A • Ol At. ^�a1 •• a ar �,• r;1T. •• J4� 09.: Russcil L. Cysfer APPROVED DATE LEGAL R•ig-PX7 4-C'7- •O ea—&:�444/ :+-z u 72-013 (Rev. 3/781 MUt4 I (= I F_FnL_ I TY (DF= Rt+FCC"prZnGE DEPARTMENT HEALTH AND ENVIRONMENTAL bTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 CDr4-5I TE SEWER F=l'ERtl I "1" PERMIT NO. C 800501 ) APPLICANT AL LARSON/RUSTIC HOMES POST OFFICE BOX 594 99577 694-2309 LOCATION ELEANOR_ A STREET-----.. LEGAL L 14 B D-DEBORA-S/D #2 LOT SIZE 10125 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 3 SOIL RATING CSO FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: dEF~TH= 12 LEt+7GTH= AL 25 GRFlNAEL E>EF"TH= 53 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 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 CIN FEET). REG~U I REO 'SEF=*T I G -rnr-Ftp n3I 2E= 16ZI(D4 GRLFLKDt.FS; 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. --- TFJO1 C 2 > I tJSF=ErT I (DMFS FIRE REGEIJ I REO --- 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 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. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"EF?M I T E}{F" I REn5 F>ECEtlEDER =Lx 1.9c 01 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 WITH 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 APPLICANT AL LAP.SON/RUSTIC HOMES OF AK. ISSUED BY ------------------------------ DATE- =1_Lwo ----- V4.0 t•11-1 t -J I i-- I F' FI L I T •T i1 F H CJ F"' ► _♦ 93 E � DEPARTMENT P HEALTH AND EN' -i IPONMENTAL I:-,OTECTIOU . 825 STPEET, ANCHOPAGE, AK. 264 -472O t3L+ C�tJ—•= i TE = E1417r- F•EF_<r1 I T PERMIT NO, �PLICANT bL -s&",tw- ?CATIONPo,�o! S9¢ 'i"�e' _GAL L LOT SIZE IIf Ws `•QUARE FEET 1 - 3K +� - ?PE OF SOIL ABSORPTION SYSTEM IS: r,,tA� -wil-11-11.1 NUMCER OF CEDPOOti =3 SOIL RATING <50 FT:'BP.?= gS! AE PEOU I RED SIZE OF THE SOIL fiE:SOPPT I ON SYSTEM I S : i i f •F=F=•TI-1== ISL LEt-4oTF-r>=a F:11%. -PEI— C•�F-THS nl THE LENGTH DIMEII=ION IS THE LENGTH (Irl FEET? OF THE TRENCH OR OF:AINFIEI_D. THE DEPTH OF A TF..EN H OR PIT I`_+ THE DI_'ANCE BETWEEN THE SURFACE OF THE GROUND AND THE COTTOM OF THE EXCAVATION (IN FEET). THEFE IS NO SET WIDTH FOR TRENCHES THE r,RA'•!EL DEPTH 15 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTiJM OF THE EXCAVATION (III FEET). :Erl1_i Z FZ:EG• = EF T I C TFit-JF� :r -I ZEE lOa� �3► 1LLClt-J _PMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPAPTMENT DUPIFIG THE ISTFiLLATION INSPECTION_ OF ANY I•JELLS ADJACENT TO THIS PROPERTY AND THE PIREP OF FESIDENi:ES THAT THE WELL WILL SERVE. -- TI•1c,< ` ? I tJ=•F•Ei-_T I OtJ=• 1=iF:E 1=:I CSU I F= FF_ - --- iCY.F I LL I NG OF AFlY SYSTEM WITHOUT FINAL I IISPECT I Otl AND APPROVAL BY THIS :PAPTMENT WILL BE SUBJECT TO PPOSECUTION. ;NIMUN DISTANCE BETWEEff A WELL AND ANY ON-SITE SEWAGE DISPOSAL S.T'STEM is it) FEET FOR A PP.IVATE WELL OR 15O TO 200 FEET FROM A PUCLIC WELL DEPENDING >ON THE TYPE OF PUE'LIC WELL. 'fill -11.1M DI TANCE FROM A PRIVATE WELL TO A PRIVATE _cEr lER LINE IS 25 FEET AND 1 Fi f OMMU11I TY SEWER LINE IS 7' FEET. a_L LOGS APE RE�.!GIRED AND MUST BE PETUPNED TO THE DEFAr^.TMENT WITHIN 3'O DAYS . THE WELL COMPLETION. -HLF* REQUIREMENT_ MAY APPLY. SPECIFICATION= ArID CONSTPUCTIO?i DIAGRAMS APE 'AILABLE TO IN_UPE PROPER IN .TAI-LATION I -T- E: -:P I CEF:TIFY THHT I AM FAMILIAR WITH THE REOUIPEMENTS FOR ON-SITE SEWERS AND WELLS AS SET !PTH SY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REOUIPE ENLARGEMENT IF THE :SIDENCE I5 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. rtlED:---------------------- APPLICANT :SUED BY ,_lam _ _ Q --DATE-- ---------- V4. O Russell Oyster 694-2774 Performed for. e0kN /01N O & E ENUNEERING & DEVELG, MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Mailing SOIL LOG La 2s6 Legal Description:Depth (fest) Soil Characteristics 0 1 2 /rl'. - � 1 9.-"1-- - 2 -7 5 �/ 3 4 5- 6- 7- 8 W r-rw Earl Ellis 688-2280 Tel .0.67d - Z. 1J,r 9`�5 It Z C 9 �j r Air— 4-1 C S� ` �� PLOT PLAN 11 Levis' -- 12 13 PERC.TEST 14 _ 15 16 Ground Water Encountered: Yes No If yes, what depth— Proposed epth Proposed Installation: Seepage Pit_ Drain Field Comments: "' ^ Performed by: �� UsS '�y �sTz� Date: �E� lb �98y STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or modification of In public water system located Alaska, submitted in accordance with 18 AAC 80.100 been reviewed and are ❑ approved. � conditionally approved (see attached conditions). 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. B. APPROVED CHANGE ORDERS Change (contract order nor a e dpNw Mfweme) Approved by Date lya•VG 1Irj.AzA 1 j!eJ«ee%%e7 Jr�wllA AG WCII Z.it'J%JiC We1VG- 1Ur;fe'Je/ feper41/u1j /CiWft{TO/l eLiA I anU ejerarP,q Fe C. APPROVAL TO OPERATE r� Orli WejVCP� The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the LJ I fh'5o N&A public water system was completed on 4y7y a (date). The system Is hereby granted Interim approval to operate for 90 days following 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 constructed according to the approved plans. The system Is hereby granted final approval to operate.r- j�� AL%/eMln/ e{l Gnyln e r/' BY TITLE DATE 18"7 (Rev. I I#" DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Se tKm C) 3. PINK. ENGINEERIMUNI-BOROUGH (Complete Secll n C) e. GOLDENROD . MUNIBOROUGH(Compote Seetlal A) 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) Lc'f l u- lgs K !---> Location (address or directions) SIS'7 (b) Applicant Name L"—•e- Telephone: Home Business Loh " SIII Applicant Address !E;I�_ 61 � � - r�=G�� y '1`15'11 (c) Applicant is (check one): Lending Institution O ; Owner/builder Buyer ❑ ; Other ❑ (explain); (d) Lending institution Telephone Address (e) Real Estate Company and AgentR�nn ma-' Address 1� /K� Teellephore IA'-f.m M Me -rine HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Mu!n-Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well O Community K Public ❑ Note: If commun ty yell system, must have written confirmation from the State Department Of attesting to the le;al;y and status. 4. SEWAGE DISPOSAL Onsite ¢' Putl,c ❑ Community ❑ Holding Tank ❑ ,at Note: if community v.ell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 �. ENGINEERING FIRM PROVIDING .ASPECTIONS, 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►* Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and ado T' j for the number of bedrooms and type of structure indicated herein. l further verify that based on the information obtain 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 Address Date _ Telephone 6. DHEP APPROVAL Approvedfor bedrooms by��//Date Approved Dis roved CondrftQnal Terms of Conditional Approval oh2P] CAUTION :E F 4k�ti Na. 1457E p�OFES510N�' e/— !3--3.- The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval cerif Cates 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(f 111 UI A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: (� t4- guy If A. B. C. D.E.C. Approved (VN) Well Log Present (Y/N) Date Completed Total Depth Cased to Depth of Grouting — Static Water Level Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/I:11WAing-Tank on Lot A4- 1 .<1 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 12- 1 ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole — —To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by '54,5 G 1 ti +a h ; Date 0-2_57' 6W Water Sample Test Results Comments Go.�otrto— 4>?P2oJA`L- lar �a.`' atJSTc--.�.—T B. SEPTIC/HAl=DM TANK DATA Date Installed Size t L—� No. of Compartments 2- Standpipeso?N) Air -tight Capso?N) Foundation CleanoutgreN) Depression over Tank (YIAQDate Last Pumped r-3 -1 Pumping/Maintenance Contract on File (Y/N) _Z70-1 ;for Holding Tank High -Water Alarm (Y/N) —""/A Temporary Holding Tank Permit (Y/N) N A Separation Distances from SepticfiieldingTank: 1 To Water -Supply Well los' To Building Foundation 1'7 To Property Line to 1'} To Disposal Field 1 µ"1 To Water Main/Service Lifte t �� t To Stream, Pond, Lake, or Major Drainage Course N A Comments Page 1 of 2 72-026(11;64) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 85'¢'J6a— Type of System Design TR 6-'c to Date Installed '1- 182-8[7 Length of Field 24 f Width of Fialel 3 % Square Feet o1 Absorption Area S15Lt `a Depth of Field I Gravel Bed Thickness g4 Standpipes PresentVRN) Depression over Field (Y/O Date o1 Last Adequacy Test B- t $-42,5' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1 Zt i To Property Line t o 1 To Building Foundation Lot a To Water Main/Service Line I r+ To Existing or Abandoned System on On Adjoining Lots slz� -f To Cutbank (if present) N 0 To Stream/Pond/Lake/or Major Drainage Course N To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in GallonsManhole/Access (Y/N) "Pump On" Level at IV 'Pump Olf Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Check Permitted Bedroom Rating Against HAA Request •• Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ & F E4G1;J-e-11yE Date 9-/Q -Gr- Company, SF 0 1661- -^— MOA No. $.S Q0 PH. E^4-2'WO Receipt No. '�5 S 3 V Date of Payment Ci - Amount: $ 'Ll ;" OL7 Page 2 of 2 72-026 (11,841 n. CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ap TELEPHONE (907)562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER II . TO BE COMPLETED BY LABORATORY WATER SYSTEM: (') See h on back to. NO. Water Sham Nemo Pfiona No. Mailing Address A SAMPLE TYPE: .Routine ❑ Check Sample (for routine sample t ❑ Treated Water with lab roto no. B ❑ Special Purpose Untreated Water SAMPLE Time Collected NO. LOCATION Collected B�y� 7- 2 2 01T3g>/ZA �yy-Z 3 I 4 I 5 I I Analysis shows this Water SAMPLE to be: d 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 ddeeliveryry/mail. Date Received Time Received Analytical Method: ❑ Fermentation Tube Membrane Filter Lab Ref. No. Result' Analys I I Q7 I I m I m I m .M of ee 2/100 wr a Me a Ibvu.. aammn. 0612200) BACTERIOLOGICAL WATER ANALYSIS RECORD Fier. tale READ INSTRUCTIONS Membrana Filter. Direct Count Collfonnfllx)ml Verification: LTB -BGB Final Membrane Fllte sults 0 Collformimo0mi BEFORE Reported By �1/y1/' Date Time: a.m. p.m. COLLECTING SAMPLE TNTC= Too Numerous To Count