HomeMy WebLinkAboutT15N R1W SEC 8 LT 691 15N PcLD
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a.^ MUNICIPALITY OF ANCHORAGE "id".
Di. ITMENT OF HEALTH AND HUMAN SER\ ;S
Environmental Health Division
825"L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
nda,e:, � / _ TO SEPTIC ABSORPTION
/ / FROM TANK FIELD WELL
�C t //Af'914
L�Ct� AIG li WELL
Pnonetsf ermit No. No of Bearooms !!� ' all
33 - 19 S3 4 6.S 3
LEGAL DESCRIPTION LOT LINE /0 /0
Lal BLOC=— Subdivision
FOUNDATION
Township. Range. Sechon
/AS -BUILT DIAGRAM ISnow location Of well. septic system, properly lines, foundation.
f driveway, wafer wales. etc I
�! T NKS
SEPTIC ❑ HOLDING
Llarlwachder Ir apacay m gallons
TYPE OF SYSTEM
❑ TRENCH ( BED
❑ W. DRAIN ❑ OTHER
Depth to pipe Whom hom
IlFohgmai graae Da
FT
Total depth from Original glace
• to
FT
Ell adJec apdve Ong.Oafgra0e '
'? f
FT
Gravef depth beneath pipe
O.IS
FT
Greve. leng:n
.30
FT
Gravel wid:n
23
FT
IOlal adsorption area
6 90
SO FT
I Distance between lines
1 6
FT
Numoml of nes
T
50r1 rating
ISO
SO FT
Pipe matevmt
011C D 302a
�ns:a'cr
h9c-tica9� E c.
.ate Inflailed
3 - 2 96
WELLS
PRIVATE
❑ OTHER Ildentilvl
GaU,Lta?yn tl`44 .
I IOld' Dep1n
I cases to
&U"Date mslaned
uLL/C44/✓
REMARKS:
Scale:
Inspections Pedofined by
oat 3//2/96-
00 ,r
n..r rly
1 4" vw eerBly that this inspection was pedwmed according to all
Ems► %*VW, &ham
Municipal and State guidelines in Ellett on Ilus dale.
Health Department Approval: �• „a Date.
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' DEPARTMENT OF, .EALTH AND ENVIRONMENTAL Pk_&CTION
025 L S1REU1, ANCHORAGE, AK 99501
264-47w
L71\7—!D I'T-l=- SIEE WI=FR F=.1=-{Rt'•'I I -f-
'I'A Ill HEI: 060065 HAND WRITTEN %J cy"W."
)F,IE I65UED: 03/07/06 fcq'.--eewc.
APPLICANT: MARK KRIEGER
QDRESS: 149 MICHAEL COURT #1
ANCHORAGE, AK 99504
;CNIACT PHONE:, 337-0953
_LGAL DESCRlP: SUBDIVISION: NA LOT: 69 FLOCK: NA
SECTION: G TOWNSHIP: 15N RANGE: 1W
_01 SILL: 2.5A (SUXT. OR ACRES)
certify that.
1. 1 z,m familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
_. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
0. 1 will adhero to all MOA and State of Alaska requirements for the set batt::
distances from any existing well, wastewater disposal system or public
nowerage system on this or any adjacent or nearby lot.
.1 Fi LIFT STAIION IS INSTALLED IN AN AREk COVERED BY MOA BUILDING CODES,
IT;_I1 (1) All ELECIRILF;L PERMIT AND INSPECIIUN MI.1S1 DE UUTAIHLD; (2) AS-DUILTS
All I'MI It. A'PROVLD WIIHOUI AN ELECTRICAL INSPECTION REPUkl; AND (3) THE
I.Lt:IIAL,i;!_ Q Q' HOST DE DUNE BY A LICENSED ELECTRICIAN.
;I 1dEUCTy 5 rC \ DATE: JVJ�Az
I I'L lCA I : MARL RIE, '_R
f;'"UED fly ��F�t�BI ., �Q. �j �/a�..�o DATE.
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Municipatity
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Anchorage
rdi
P.O. L „( 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TONY KNOWLES.
MAYOR
DEPARTMENT OF HEALTH 6 HUMAN SERVICES
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SRB I%x C -MPUTATION SHEET
EaLd* tier, Alaska 99577
SUBJECT: L 6 51-- 58 T -I N, - 2 a (J - 5 VI
n
DATE:
SHEET OF
BY
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0 P\ ( Z� r , �, . fENG1'NE€R'S SEAL)
Municipality of Anchorage r : ;' �•t fp`
DEPARTMENT OF HEALTH 8 HUMAN SERVICES
J
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST r` ' t .sen A. 5heFa ' :~4z, %
PERFORMED FOR: / �✓ // /L ✓ COj S DATE PEI ZZiii: v%��H 6 f3
LEGAL DESCRIPTION: / �/ V e/ l Township, Range, Section: /5 A-)
DEPTH
(FEET) C%�Q �',C 1-e CAD —r
1
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3 o
4 b
O
5 r o
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6
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7-
91011 9-
10-
11
12-
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14-
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16-
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19-
20
21314151617181920
COMMENTS
C W — /00 '�Iotf
Co UAJ A 6 e11141a.
G-lvf -CG e7�jre/
SLOPE
WAS GROUND WATER
ENCOUNTERED]
3 •L3— f3 IF YES, AT WHAT S7
DEPTH] CJ
Depth to Water Alter t
Monitoring] 17 Date�r�q-p1
k
PERCOLATION RATE (minutevinch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND ::--FT
PERFORMED BMS 196x qq ��J I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STA EfAND MUNICIPAL GUIDELI FFECT ON THIS DATE. DATE:
72-008 (Rev. 4185)
a
MlJf�l I C S r'AL_ I l -Y (�F ANCI-iOfzAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
a25 L STREET, ANCHORAGE, AK; 99501
264-4720
CJN-8 I TE WFE: 1—L r Er�l"1 I -1-
FERMIT NO: 06004"
DATE ISSUED: 02/13/06
AFFL I CANT: MART: KR I EGER
ADDRESS: 149 MICHAEL CT. #1
ANCHORAGE, AK: 99504
CONTACT PHONE: 337-0953
LEGAL DESCRIP: SUBDIVISION: NA
SECTION: 0 TOWNSHIP: 15N
LOT SIZE: 2.5A (SO.FT. OR ACRES)
LOT: 69 BLOCK: NA
RANGE: IW
0
I certify that:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
5. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
SIGNEDDATE:
APPLICANT: MARK KRIEGER
1SCUI_ll BY �J A DATE
--------------------
7-6,-. s u e- // ,s L� l i f
pc,../6-! � r .meq L✓ i f �a.i�.ti' � rs.T'
b�
C�ptifi�ed 4rillingDOC co*001
��ng
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUG IAK, ALASKA 99567 • TELEPHONE 6882759
OWNER OF LAND 7DEPTH 0I ,SELL 75 1 •�-
ADDRESS �7 �'9 1 C .H r�7F1- C" Z 1 A �4H yy�SO ,TIC LE\'EL OF t,:\TER FL �O Z•
LEGAL DESCRIPTION C /!� Sty
DATE. - Started Ended
i
PERMIT NUMBER
KIND OF FORMATION:
DRAM 1)01,N FT
GALS. PER HR '7d o
KIND OF CASING (,' J o
From ' '
Ft. to :' FI.
CAS""
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from F
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to
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MISCL. INFORMATION:
r;.i .: ��w ^, r✓ 4
Mi.•V f,
�ss74
From Ft.
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL 7�
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date 9/8/86
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 69 T15N R1W Sec.8
Location (address or directions)
T15N R1W Sec.8
(b) Applicant Name Mark Krieger Telephone: Home 688-0370 Business N/A
Applicant Address 149 Michael Ct. #1 Anchorage, AK 99504
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder G ; Buyer ❑ ; Other ❑ (explain);
N/A
(d) Lending Institution !,Firs t Guaranty Mortaaae Telephone 276-3949
Address 307 F. Nnrthern f,ight4 #201, Anchorage, AK 2950'
(e) Real Estate Company and Agent N/A
Address
Telephone
(f) Mail the HAA to the following address:
Pick—Up by Engineer
2. TYPE OF RESIDENCE
Single -Family (2 Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well Eat Community ❑ Public ❑
r
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:9 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 72-025 11+,64)
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 verify that my investigation of this t4ealtfi /•
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. *exempt from sand filter requirement, refer to checklist
Name of Firm section C. Telephone
Address E LE !VFR ENGINEERfNG-6ERVIGG6
Date 1Gf 71k -C EAGLE RIVER, AK 99577
F. 0. BOX 773294
694-5195
tri .0,.»O.�Q.y��•4j
oa C
Eng`r elr's Seal
c 736
L1 c •, Louis A, Butere ;� 4�6f�
6. DHEP APPROVAL
Approved for 7211w bedrooms by fir '`^ '�' �' Date
Approved L__� Disapproved Conditional
Terms of Conditional Approval
30
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
72-025 (11/64)
MUNICIPALITY OF ANCHORAGc
DEPT. OF HEALTH 6
EN^gNA4ENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA) r,
HEALTH AUTHORITY APPROVAL (HAA) OCT 2 710
CHECKLIST - FEBRUARY 1980
2840720 RECEIVED
Legal Description: L o f y %/S /✓ I?iuJ
A. WELL DATA
Well Classification P4 / 0 A -r,,-- If A, B. C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Y Date Completed%7ftr! Yield
Total Depth 176 " Cased to ass Depth of Grouting tit's
Static Water Level /0 a Pump Set At /-�?-
�y
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot 1/31 ; On Adjoining Lots Y�Go
To Nearest Edge of Absorption Field on Lot On Adjoining Lots
To Nearest Public Sewer Line IVA To Nearest Public Sewer
Cleanout/Manhole N/4 To Nearest Sewer Service Line on Lot s -
Water Sample Collected by Date
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 31Ve Size ?-/ No. of Compartments
Standpipes (Y/N) y Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) _Y
Depression over Tank (Y/N) N Date Last Pumped
Pumping/Maintenance Contract on File (Y/N)
^/ ;for Nom`
Holding Tank High -Water Alarm (Y/N) - G Temporary Holding Tank Permit (Y/N) tic
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 113"
To Property Line 30
To Water Main/Service Line f /O
Course !!!;//_4
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation
To Disposal Field -7
yv e
To Stream, Pond, Lake, or Major Drainage
r _
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata / O 4n ��� Type of System Design
Date Installed L5 -z Length of Field
r
Width of Field 3 Depth of Field
Gravel Bed Thickness ✓�
Square Feet of Absorption Area �i% Standpipes Present (Y/N) ,y
Depression over Field [Y/N) ^) r^'^^ °-R^ Date of Last Adequacy Test Af
Results of Last Adequacy Test 4,ew Nor
Separation Distance from Absorption Field:
To Water -Supply Well°J To Property Line ±3e
/
To Building Foundation s` To Existing or Abandoned System on
Lot
4 ; On Adjoining Lots X30
To Water Main/Service Line ��0 r To Cutbank (i1 present)
To Stream/Pond/Lake/or Major Drainage Course wit
To Driveway, Parking Area, or Vehicle Storage Area
Comments'r S 6 s ,. f� a /_. c A f, r S, It t
i •"I/+f c t/.-.. r� e t is Y-4/
s
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)
"Pump Off" Level at
Check Permitted Bedroom Rating Against HAA Request '•
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
* I certify that I have checked, verified, or conformed to all MOAand HAA guidelines in effect on the dateof this inspection.
l �—
k ��o ✓
Signed Date /0%?/E if
Company MOA No. 37' 16y
Receipt No. Ce/ OOD
Date of Payment
_..�''�° �Cp�
ti3'
/�
Amount: $ i6r.
4 ;,..•••p lE*'4 - Seal
0. .V yye..l0.ip... �..
/�/�;,F„�t�;
Page 2 of 2
d
t, Louis A. Cutcra l.w
72-026 n coat
Ije J'/, :�. CE -6736