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HomeMy WebLinkAboutDEBORA #2 BLK F LT 10 I`I PAR( Foow Loov# OYO 04Z 0f Ooo MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME —� O E �E.VTE/2 PHONE `/ 695- y9Fz UPG ❑UPGRADE [3 MAILING ADDRESS ::5, 4. �3ok /Q 74 /% 'Egate vC CIE—IZ• Ate. else 77 LEGAL DESCRIPTION Lor/ g1ul. , LOCATION n7���N v,e�dE �! I2is Sr. NO. BEDROOMS 3 0'e DISTANCE TO: Well , /Z$ Absorption area 7 Dwelling, Z7 PERMIT NO. 7 e92O aZ a Manufacturer 5u.�sEr PZ4ST/ 65 Material No. of compartments y F��Ee� cA3 S Liq. capacity in gallons On IF HOMEMADE: Inside length Width Liquid depth d Z DISTANCE TO: Wetl Dwelling PERMIT NO. V _ ? f Manufacturer Material Liquid capacity in gallons W = DISTANCE TO: Wall �5 / Foundation 3 3 , Nearest lot line , PERMIT O. l�P3La _,LL Z No. of fines Length of each line Total length f lines Trench width Distance between lines I- S t .Inches F- Top of tde to finish grade , Material beneath tile Total effective absorption area O 9 Z inches 56 F7-, W Length Width Depth PERMIT NO. <I-- W a' Type of crib CnD tliameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS 4 n Pec 'S a<WEe d 4 vret c D,e/! /N P1,PC SOILTESTRATING O 3r DC IN DO INSTALLER C/N.9,2LE S 6s122 eeV7Xf%G7a2. r t Ir OJ REMARKS OF'At. "'�'s aI TI 051r-- ow �'� . -Y •. 9 1 i -P- ,yov,,%,rys 00 EP IELL iio Earl P. Ell r� / C NO. T745•E APPROV �D� DATE LEGAL /o z 9,1� LorT 72-013- (Rev. 3/78) Mutt I i_ I F' qL_ I T'T EDF At-4C2V1e-000103E DEPARTMENT Ov.HEALTH AND ENVIRONMENTAL F_JTECTION 025 'L' STREET, ANCHORAGE, AK. 99501 264-4720 ED 44 I TE-•Ef•IEF_• F•EF:P1 I T PERMIT NO. t 780820 ) APPLICANT JOE SENTER SR BOX 147A EAGLE RIVET: 694 9982 LOCATION MERCY & IRIS ST LEGAL L1 BLK. F DEBORA #2 LOT SIZE 9768 SQUARE FEET TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSC? FT/ER)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: LAEF"IFvi= 11 LEtJC3IF64 liA" C3F:ANYKL_ GEF IF VA THE LENGTH DIMENSION IS THE LENGTH (IN 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 F'IF'E AND THE BOTTOM OF THE EXCAVATION CIN FEET). Fw:E-ZG IIJ I F:EC� =•EF'T I C IF n" K S~ I cE= 1C-iIDEy r3AL_L0t}I'= 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. --- TL4I-D C � ] I I -J= F=U CT I Ot-d=• AFZE F=:E�=! I I F:EG --- 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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. AEF? M I T E F• I F= ES 1 !D r :- I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY'THE MUNICIPALITY OF ANCHORAGE. 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 KWMODELED TO INCLUDE MORE THAN 3 BEDROOM_. SIGNED ISSUED L DATE____ V3. 2 0 & E GEG'ECHNICAL & DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 6942774 or 68 -Uau Russell Oyster 6942774 Soils 6 Foundations SOIL LOG Performed for: Name: C'`'''' '`� - -- � � � Tel. No. Mailing Address: Legal Description: Depth (feet) Soil Characteristics 2 3 ; 4 5 6 rl 8 9— lo— ll 1011 12 13 14 16 Ground Water Encountered: Yes No If yess what depth Proposed Installation: Seepage Pit Drain Field Comments: i, Performed by: Date: Earl Ellis 688.2280 Land Development by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 6942588 OWNER OF LAND rJj e,u r k i TG'O %! ADDRESS LEGAL DESCRIPTION - I .. L . . DATE -Started Ended -^7—/ PERMIT NUMBER J L DEPTH OF WELL too STATIC LEVEL OF WATER FT. i DRAW DOWN FT. 4<) GALS. PER HR ? o r KIND OF CASING �• ^ o O KIND OF FORMATION: r Ft. t._2 2 From ` � D Uc Ft. to � Ft. 1 tide O z' ''J From FL to Ft. From Ft. to 2 Ft. •SAS Q (R rr...'L t't'�C� r—roI rom—Ft. to Ft. From Ft. to Ft. J4 —ci S 70wF From Ft. to Ft. From " Ft. to Ft. SN r' From Ft. to Ft. From FL toFL - S/' <1S T -Ar_ From Ft. to Ft. From % Ft. to _) Ft. / Tf c From Ft. to Ft. From r Ft. t._2 2 Ft. S11-0 Si (-UC S/tt'-v--V F om Ft. to Ft. From " Ft. to f J u Ft. St; 5 i c "- - From Ft. to Ft. From Ft. From Ft. to Ft. Ft. From From Ft. to Ft. From From Ft. to Ft. From From Ft. to - Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to From Ft. MISCL. INFORMATION: �I t , C1 '` T T,i, From Ft. to Ft. From Ft. to Ft. From Ft. From Ft. From Ft. From Ft. From Ft. From Ft. From Ft. ec-t=Lq I�o`t r�ur�F I c Ir`FiL I TY OF= r1r.JcFriF<r��E �J DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION £25 'L' STREET, ANCHORAGE, AK. 99501 264-4720 WE=LL F'F=FZM I T PERMIT NO. C 7£0056 ) APPLICANT NORA EKSTEDT BOX 923 EAGLE RIVER 694 2354 LOCATION MEk�Y F< IP,IS LEGAL L1 BF DEBORAH #2 LOT SIZE 10165 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL, 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=MIT F=XF~ I FZ =f> ©F=CT =MBEFZ ZZs 1n+7L 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. SIGNED:__C�_�`_e' 6 % ---------------------------------- APPLICANT NORA EKSTEDT ISSUED SY-01 _'i�1s.c�tc �----DATE 4_e_1_17_E --- V3. 0 /'i L10�nkn aC kNoolz ..C��r W e�, 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 June 24, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 10# 1, Blorb E1 AnhaE__SubdiyiALon Location (address or directions) 16733 Alo2c(/ Vn;ve (b) Applicant Name Afan,ianno HPimA Telephone: Home 694-59RQ Business 5A3 -377A Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution ttonn� iff lynch Pnnpehty Telephone Address (e) Real Estate Company and Agent u�e____h�tag¢-fLOMOA. nape PAire AddressRn_ Y M FagP¢_R ph,.gpadr-Eagpe-RiuvA Afaska 99577 Telephone - 49d -d994 (1) 99Ce HAA to the following address: S d S Englnee2Eng SRB 196X Eagle Rim, Alaaha 99577 aadeaed by Dale Rice, 2. TYPE OF RESIDENCE Single -Family 1A Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Q Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite R(1 Public ❑ Community ❑ Holding Tank t3 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 72-025 111,84) n � 5. ENGINEERING FIRM PROVIDING . SPECTIONS, TESTS, FILE SEARCH, DAT. ND 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 —S&S -ENGINEERING.— Telephone lam ' Zf! 7 f Address SR -B -496X Date EoGLEBIVERr,AK99577 JUL 1 1936 6. DHEP APPROVAL Approved for '��j bedrooms by _ Approved K Disapproved Terms of Conditional Approval Conditional CAUTION or, •'%Or ..ate, eal L.A•A. Shabr t4s. 1437.E % Date 7-3 — Fe, 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 72.025 (11/84) MUNICIPALITY OF ANCHORAG: t� /0�)DEPT. OF HEALTH g MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) J U L O 2 ti0 CHECKLIST - FEBRUARY 1984 284-4720 R Legal Description: —L-1zly I ( E V r [µms/ A. WELL DATA Well Classification - ��' F• If A. B. C, D.E.C. Approved (Y/N) a/P Well Log Present®/N) Date Completed 3' Ic>'7F3 Yield ZoGa'N '}" r Total Depth I oo Cased to I mo Depth of Grouting Static Water Level CJI Pump Set At01(— Casing Height Above Ground �� Z� Sanitary Seal on Casing(PN) Electrical Wiring in Conduit4WN) Separation Distances from Well: Depression Around Wellhead (YQy To Septic/Holding Tank on Lot (if ; On Adjoining Lots I dor-4- To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots (oo r t To Nearest Public Sewer Line �A • To Nearest Public Sewer I Cleanout/Manhole To Nearest Sewer Service Line on Lot ' 'F Water Sample Collected by yDate - 11,0'240 —$(� Water Sample Test Results Comments �) 1lr:A"r> S 20 GnPti B. SEPTICW� TANK DATA Date Installed 10.1118 Size LG)Gk:> No. of Compartments Z Standpipe/N) Air -tight Caps®N) Foundation CleanoutdnN) Depression over Tank (Y(IV Date Last Pumped Pumping/Maintenance Contract on File (Y/N) P ; for Holding Tank High -Water Alarm (Y/N) 1A Temporary Holding Tank Permit (Y/N) "M Separation Distances from SepticEMelding Tank: To Water -Supply Well To Property Line ) c To Water Main/Service Line _ /o f Course Comments Page 1 of 2 72026(11/64) To Building Foundation r To Disposal Field �{ To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /Oo X104' Type of System Design Tdr-r� Date Installed 10-1- 76 Length of Field 4-31 Width of Field 3b Depth of Field dq Gravel Bed Thickness 3 '/2 - Square Feet of Absorption Area 3c I Standpipes PresentON) Depression over Field (YAQ / Date of Last Adequacy Test L'Z-7 ' BL Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1 1 S To Property Line o r To Building Foundation 3'� To Existing or Abandoned System on Lot ; On Adjoining Lots 3o f -4 - To Water Main/Service Line t,l To Cutbank (if present) a P To Stream/Pond/Lake/or Major Drainage Course aIA To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at N, "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Pumping Cycles during Adequacy Test. Meets MOA 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 SSSENGINEERING — Date 1936 Company $R 13 I9iSX MOA No. C90 3 Receipt NoE.AGLE RIVER, AK 99577 Date of Payment OC Amount: $ Page 2 of 2 72-026 111,84) 140. tu7; / err ' ( 1 CHEMICAL & GEOLOGICAL LABORATORIES. OF ALASKA, INC. TELEPHONE (907) 562.2343 5833 B Street) ^" Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria Y TO BE COMPLETED BY WATER SUPPLIER TO BE�COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.M Anaiys(s shows this Water SAMPLE to be: �LPRIVATE WATER SYSTEM Name Phone No. 5" «1, A 1 Mailing Address } _r*Le� Alt- 7 City,, state zip Code SAMPLE DATE: c1zLv'-1 II Mo. Day Year SAMPLE TYPE: Routine ❑ Check Sample (for routine sample with lab ref. no. ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLEj Time Collected NO. LOCATION (. Collected 1 1 Go -r i g F 2 3I a I I Satisfactory ❑ Unsatisfactory ❑ Sapie too long In transit; sample should no be over 30 hours old at examination to ndicate reliable results. Please send ,-new sample via special delivery mail. t� Date Received o Time Received Analytical Method: Membrane Filter N00 colonies/100 ml. Lab Ref. No. Result* Analyst s i iii l E0 READ INSTRUCTIONS RFFr1RF BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: Coilformllooml Reported By • .1"� %w Date (')la Time: ? lJ a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria .I t-- t5� tee., ww MUNICIPALITY OF ANCHORAGE •��NI LITy OF ANCHORAGE fin/ O DEPARTMENT OF HEALTH & ENVIRONNIENTAL PROI'Etiilr�''T7e' LL.�• " - - 825 L Street • Anchomr. Alaska 99501 IaEPT. OF HEALTH & ,whit) o.[.• !��)� ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION �p Telephone 2G4-4720 NOV & 19781 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SRECE PVkDs 1 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please alloN ten (10) days for processing. 1. PFOPER Ill r'OWNER FjoO p' '.tAiLI!:s��J�}lstJ_J Pf'I)�iTY HibIUENT 11 tddfe.entlrom��'� � —f — � PH NE lSll 2. y PHONE G_�`—/— R1AIL' ;IAA UD' 3. LE 4' NG INSTITUTION PHONE ADDRESS PHONE ADDRESS 4Nnen_mC. . a?Ll-2�a 1 S. LEG^ SC IPTTI N t �'ICATION 6. TYPE Oy�FjL,HESID dE SINGLE FAMILY NUA13EH OF BEDHOULU ❑. One ❑ Four ❑ Other ❑ MULTIPLE FAMILY ❑ Two ❑ Five Three ❑ Six 7. VIATER SUPPLY INDIVIDUAL' ' 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. SEVIA�ISPOSAL SYSTEM INDIVIDUAL/ON-SITE" *elf individual/on-site, give installation date,�_7 , v PUBLIC UTILITY If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-01019.73) I I- ILI-1q- b m n t-1 W� nota. Bio U Ufi 1 11 'L' 010 1 Rrs. W781 THIS SIDE FOR OFFICIAL USE ONLY - DATE HECLIVLD INSPECTION APPOINTMENTS j1; E TVAE TIME DATE DATE 1>: 'ECTOFt INSPECTOR INSPECTOR .IF ECTIONS: T. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER .=, ] MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SIX PERMIT NUMBER 2. NATER SUPPLY INDIVIDUAL DEPTH OF WELL COMMUNITY ._ DATE DRILLED PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUN. BER _i INDIVIDUAL/ON •SITEzaIrko DATEINSTALLED PUBLIC UTILITY Connection Verified INSTALLER i::Eep�t1ieTank o�r ❑Holding Tank ;ii7.': _.7.1A_.« If Tank is home de SOILS RATING c.v^ dimonsions: IOmO _'_Y,,[ OF TANK MANUFACTURER -.O"iAL ABSORPTION AREA MATERIAL 4. DISTANCES ScpUe/Holding Tank Absorption Area Sewer Line Nearest Lot Line WELL TO: >i,vmn Arca to nearest Lot One 5. C0=r1'.1ENTS ' ��. PPROVEDFOR�— BEDROOMS ❑ CONDITIONAL APPROVAL (letter MLI , accompany certificate) rL�—DISAPPROVEED ./ BY (Tit t F';AL 'SCRIPTION 'L' 010 1 Rrs. W781