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HomeMy WebLinkAboutKASILOF HILLS BLK 8 LT 9 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 INSPF. CTION REPORT NAME '~-AI LIN G ADDRESS LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS .-L~ ~ Well ~ IManufacturer ~1:~ ~ Materia~. No, of compart~nts ILiq. capacity in gallons IF HOMEMADE L [ Inside lengtl~/..~lz ~ Width ~ , Liquid depth W/~- ~ ~ I DISTANCE TO I Well ./Dwelling i PERMIT NO. ~ P I Type of crib Crib diameter . //Z Crib depth --I el . ,. ~ ~ / V/[I ~ ~ ~ DISTANCE TO Well / Buildin~ foundat,o~; --~ IClass Depth ~ilJ~ ' DISTANCE *O Building foundation m area(s) OTHER PIPE MATERIALS ,/-/~ ~C(.?R ?o'/vrco SOIL TEST RATING INSTALLER REMARKS 3034 APPROVED DATE LEGAL S &S ENGX IEE11S SOILS 7125 Old Seward Hwy. Anchorage, AlaskD 99502 349~6561 PERCOLATION TEST SOILS LOG- PERCOLATION TEST 5 6 7 8 · 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE Sire PLAN 't~;T-,/ -0 I , . :' .h,: .: . MI..- WAS GROUND WATER S ENCOUNTERED? ,~ 0 L O P E IF YES, AT WHAT __~ -- DEPTH? Gross Net Depth To Net Reading Date Time Time Water Drop ..... ~ .... IO~ _ ~,n~ , I ~/~ 5~" lO / !o ', ~ 4.~,~ ~ '%~" ~ oo o JOHN E, SWANSON 1834-E PERCOLATION RATE TEST RUN BETWEEN { ~ (minutes/inch) ~i~lo' FTAND COMMENTS Permit MUNICIPALITY OF ANCHORAGE Department ': Health and Environmenta° 7rotection 825 ~. Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/~I:{ ON-SITF- SEWER PERMIT Applicant: ~ ~-~C3L~.~ ~©~.-~2__)~ Mailing Address: Location: Phone Number: Legal Description: Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Maximum Number of Bedrooms: %_~ Lot Size: Holding Tank: Soil Rating(sq.ft/br) ~'I Q_~ The Required Size of the Soil Absorption System Is: DEPTH ~r> _ LENGTH <~)O GRAVEL DEPTH y WIDTH 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(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(in feet). * * REQUIRED SEPTIC(HOt-D-I-NG) TANK SIZE = /~0~ GALLONS * * Permit applican~ has ~he responsibility ~o inform ~his department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. MiD,hum 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. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * * 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 codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. S igne~. ~/~p~//~q.~an//~~ ' ~ ~'--' Issued by: __ ~_ Date: /0 '- SWP/024(1/81) rv~-W DRILLING, Inc. P.O. Box 10-378 · '10300 Old Seward Highway (g07) 34g-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner F~l~l~z. ,~:. ¢ ~a~s(;r~A;~5%£dC'[ {O~D Use of Well~ ..- Location (address of: Township, Range, Section, if known; or distance main road Size of casing Static water level ~ ft. (~b~i Screen ( ); Per£orated ( Describe screen or perforation Well pumping test at__i/. gallons per of drawdown from static level. ),:LoL,,=r 19, l~d3 Date of completion. Depth of Hole__ '-; -~'' ~[eet Cased to_ 30 feet (below) land surface. Finish of well (check one) open end ( ,- ). (minute) for ~. hours with WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness " TO -- C~ts ir~- 230 .TO. 300 __.TO. .TO. .TO. .TO. TO _TO_ TO_ ); Organics /,ravell) Gravel Bedrock- 12~rd Bec[rock-- soft Bc~irock - Rard Parcel I.D, # 1. MUNICIPALITY OF ANCHORAGE: . ': . DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services "On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELL. lNG 015-132-06 N GENERAL INFORMATION Complete legal description Kasiloff Hills Lot 9, Blk 8 Location (site address or directions 10600 Strocjanoff Dr-ire, Anchorage Property owner Mailing address Lending agency GvrAC/MLqa o'Dell Mailing address' 460 West Tudor, Anchoraqe, A~ Agent N/A Address Richard H. & Mary Kathleen Parry Day phone 10600 Stroganoff Drive. Anchorage. AK 99!~6 Day phone 99503 Day ahone 346-1471 562-2182 Unless otherwise requested, HAA will be held for pickup. · - 2. NUMBEI:[ OF BEDROOMS: 3 -- , I i I ' ~- ' ~,~ ~ 3. TYPE OF WATER SUPPLY: ~' ........... ,~-1~.,· ''~,'.~'~'<~ ",. ' Individual well -- . .~',,< . ~ommunity well . Public water NOTE: If community well system, provide written confirmation from Sta(e A.DEC. atte~,~' " lng to the legality and status O~ ~YStem. ' 4. TYPE OF WASTEWATER DISPOSAL: X Individual on-site Holding tank ~ Community on-site : Public sewer NOTE: If community wastewater system~ provide.wrjt~ten confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER .;;; As certified by my Seal affixed hereto and as of the validation date shown below, I verify that mg'i"'. :~: investigation of this Health Authority Approval application shows that the on-site water supply ' .' and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms '" , 5, and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves.ti._gation 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 Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 5ngineeCs signature ~ Date 6. 'DHHS SIGNATURE -"~; Approved'for ';": ..¢ .... bedrooms. .~- Disapproved '~ .' .............. -,. '~,--j.:':' . .. . . . . ..... ... ........ ~ "-¢' ' :' 'Conditional 'approval for":"' ' " ....'bedrooms, with the fo owing stipulations: .,?' -'~,,I H ,- . - - - .~.'>_,,: '.. , '.Q ,~. ,/.~ . ,' :, - '-, '.. !",~ '?,.A ' '~ ' .';,~( d"?l "' ~ "; . :~:~Ad.~ition&lComr~ents'' ' i '_ . ,. ,.: c,, .,...> .. ,<,,.,,.. ,. .... ','"2'l,h, ,,.¢~,,v' /" - / By: ;~-¢-,/~ f~ ''~ Date ~/~'/~¢'~. . The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent Professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS 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, 72-025 (Rev. 1/91) Back MOA/I~I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number )/~ Date completed _ /0///?/,¢3 Driller , ~ (:)~ / Cased to 30 / Casing height y~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION (~, ~ g.p.m. /' (~ SEPARATION DISTANCES FROM WELL TO: / Septic/h~iding tank on lot Absorption field on lot Public sewer main ,/~//~ Sewer service line '/- RECEIVED g.p.m. JUL 1 41995 Municipality of An(.i t. Dept. Health& Human ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~-- Nitrate Date of sample: ~,~"~////¢~ B. SEPTIC/I'I~ TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) Date of pumping ?~',~6c/Z_ Other bacteria Collected by: ~/¢~ S Tank size / O(~(~ Compartments ~'¢ Foundation cleanout (Y/N) ~/(¢-~- Depression (Y/N) ,,',,//-,~ Alarm tested (Y/N) (~//~/';)/¢' Pumper SEPARATION DISTANCES FROM SEPTIC/~IGrbq~-RG TANK TO: Well(s) on lot ,/O/"¢ / TO properly line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3/93)° Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer Manhole/Acce~~ "Pump on" level at .~-"'~."Pump off" Level at ~-~- High water alarm level /~ CYcles tested Meets MOA electrical codes (Y/N) ~ SEPARATION DIST~ANC~FRoM LIFT STATION TO: W.~elgen~~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /~,/~ z~ Length ~'~' Width Total absorption area Date of adequacy test ~¢,////~ ~, Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) ~-/ / c~ Gravel thickness Cleanout present (Y/N) Results (pass/fail) ~.) ~.L'?/ After test /V/A If yes, give date System type T/~.~/'/C./-t Total depth ,-~ / Depression over field (Y/N) ,A/o for ~ Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~(~ / On adjacent lots /-/OO / Property line /~/(~ To building foundation 1- /(~; / To existing or abandoned system on lot it//,4 On adjacent lots 7L ~ 0 ' Cutbank ,~//~ Water,mairCservice line Sudace water /~//~4 Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe,,ct, on,:tb~;~ate,~f.,this inspection. ~' ::: (.,~" ,,'ti ~ "' Signature~ EngineeCs Name Date Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number D'F/tL4/9~ ldU:J4 [JUf'II"I~IfL:IFtL ILbl LIN[3 ~,, 'JFl'f' b'dq .3Z~." pttJ. Eh'i~ L.'~J~ CT&E Environmental Services Inc. Laboratory Division UA 2~ W. Potter Drive,, AnChoraflo, AA 9gB18-150~ -- Tel: {~7} 5~2-2343 Fax: (907) 501-5301 ENVII:~ONMENTAL FACILI11E$ IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND. MICHIGAN. MISSOURI, NEW JEfl,SEY, OHIO, WE~T VIRGINIA MUNICIPALITY OF ANCHOP~tGE DIVISION OF ENVIRONMENTAL DEPA1YI'MENT OF H~.IAL%T! AND ENVIRONMENTAL PR(7~TECTION APPLICATIC~N POR H~I~I..~I NJ'IT!ORI%~ APPROVkL CE~]TIFICATE 1. General Inforrmntion Application Date (a) ~.gal Description (include lot, block, subdivision, .~mction, to, reship, range) Lot 9 Block 8 Kasilof Hills Subdivision Location (adcl~ess or directions) Applicants N~l~ Kastar Construction %~lephone Applicants Add-tess ].106 West 29th Place, Anchorage, Alaska 99503 is (check o~) l~ndin~ Institution [ilH~ e~m~',.'/~ui~ ~, Applicant ~nding Institution Te ].epho~ Address b) c) d) e) Real Estate Co. & Agent Address ............................................................................................... three Individual Well. ~%~1 Co~rmnit:y F--[ Public ~li Note: If o~mnity well system, must ha~ w~itten confim~tion ~}~ the State ~p~e~ent of Environ~ntal Conserwd~ion attesting to t~m legality and status~ Is the ~11 adequate for the numar of ~s s~acified in this H~I (Y~) Is the wastewater dis~sal system adequate rcs the r~umb~r of ~dr<3~s (_~}~! ............ [Page i of 2] 2.-t5-84 i oez, tify that I have checked, verified, oz: confom~ed to all MDA ~AA c:,..,~zd=l..nes' ~'~ ~ in effect on the date of this inspection~ Signed Da t e Namm of Firm Te le]~h_o_.!~ ................................. Address Signed by Date This Department has received confirmation by the engineer (S & S EDgineers) that the final grading has been completed and inspected. Therefore, this property now has a fu].l approval. ( ..,.,NG INE.~R SEAL) 6. DHEP Ap~proval Appr_oved for three bedrooms Appro~d ~ Disapproved Cfi Te.m.~s of Conditional Approval By y,' ...... , ....... th,'-,, {,',,,.' ( ~('. Conditional [ifil[ l~nte ,~une 6, ].98 The Municipality of Anchorage Lb~pa~.lurent of Health and Environmental ?~*otection d~s not ~arantee t~ continued satisfactor~ p3~fo~an~ of the water supply ~d/~' the waste~te~ d].s~sal system. ~is approval indicates that, as of 't~ validation ~te sh~ ~, ~n~d on t~e data and infomnation furnished ~ an epgir~er registered in the St:ate of A].aska~ the water supply and wastewate)~ disposal system is safe and fun~. tional for the numar of ~c%:~ and t~ of structu-$e indicated. (DHEP SEAL) 7. Mail the B~3~ to the follcl,;ing add~ess: KB2/d5/s [Page 2 of 2] 2-15-84 ML~IICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEAL'f%! DEPAFdTMENT OF HFALTH AND ENVIRONMENTAL PROTECfION APPLICATION FOR HEALTH AUTHOP~ITY APPROVAL CERTIFICATE 1o {~neral Infornmtion Application Date Z.~.{-~f_~ff-j. (a) Legal Description (include lot~ block, subdivision, section~ tc~vnship, range) Location (address o~ direct:ions) (b) Applicants (c) Applicant is (check one) Lending Institution (d) Lending Institution Te ].e_phone Addre ss (e) P~al Estate. CO0 & Agent Address Multi-Family Other (describe) Individual Well ~i Coranunity [~.][ tk.,bl:i.c L]--~] Note: If comr~nitV ~ell system, must have written confir:mntion from the State Departnnsnt of Et~vironme, ntal Conservaticn attesting to the legality and status. Is the v~ll adequate for the n~dmr of bedrc~ slmcified in this HAA (Y/N) 4. ~ ~_gpos a 1 O'nsite ~ t~blic ~ C~unity ~. Holding Tan~ ~[ Is the wastewater dis~sal system adequate f~ t-3~e n~n~r of ~dro~s (Y~) [Page 1 of 2] 2-].5-~4 5. ~n~qineerin~ Firm Pro¥i~ding I~?ctions, Tests, Data and Inforn~tion I certify that I have c~mcked, verified, or confommd to all MOA K~A C~idelines in effect on the date of this i. nspectiono ( ENGINEER SEAL) (DHEP SEAL) 7. Mail the HA3% to the following ~dress: q[he Municipality of Anchorage ~.~partumnt of Heal. th a~.d Enviro~ntal ~otection d~s not ~arantee t~e continued satisfactory perfo~ncm of the water supply and/or the wastewater dis~)sal system. ~is approval indicates that, as of t~m validation ~te sh~% a~, hn~md on t~ ~nta and information fuunished ~ sn e~ie~er regis~zmd in the State of Alaska, ~ water supply mhd ~stewater dis~sal system is safe and fun~ tional for the ~r of ~du~ ~d ty~ of s~ucture indicated. .~,: ~ {~" KB2/d5/s [Pag~ 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification ~2t~___~ If A, B, o~ C, D.E.C. Approved(Y/N) ~//~___,~' Well Log P~esent (Y/N)~ ~/'~:'~ ~"/%/£!~, ,: Date Completed ~C,-~¢~- ~:~ . YieldS_' U/" Total D~pth .~0~/ Static Water I~vel _~ 1 Casing He'ight Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on [~t Cased to ~ O ~ Pu~ Set At Depth of Grouting__~ 2_J-)O / Sanitary Seal on Casing Depression A~ound Wellhead J Y~ ; On AdjoiniJg Lots~___~ ; On Adjoinin~ Lots ~_~_~-/00i To Nearest Public SeweF Line A/ /~ To Nearest Public Sewer Cleanc~t/Manhole~//~ To Nearest Sewer Service Line on Lot Water Sample Collected By ~l ~//~L~'?~____; Date(_~JD~L~ ~'/ Wate~ Sample Test Results ~,/~fl.-~c'r~/.-_%',~ m~,~3~,~ ,:~'a~w,~-,~vq 4¥~'~¢~/,~. Bo SEPTIC/HOLDING TANK DATA Date Installed /0 - ~Z( - ?5 .~ Size /DO0 ' &~q ~ No~ of Compartments ~. Standpi~s (Y~) ~ Ai~-tight Caps ~~ Foundation Cleanout (Y~) ~. ~p~ession o~ Ta~ (~) k~). ~te ~st P~d ~ .SVsra~ ~/-- P~ng~intenan~ ~n~a~ ~ File ~~; fo~ /~2~_~~ Holding Ta~ High-Wate~ ~a~ ~/N) ~/~ ~ary Ho!di~ Tank Pe~t (Y/N) ~_ ~p~ation Dzstanms ~m ~ptic~olding Tank: To Water-Supply Well To P~openty Line To Water Main/Service Line co, se _3V/ 1 . TO Building Foundation ~ f? / To Disposal F:i.eld C[ / TO Stream, Pond~ Lake, or Major D~ainage [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD(,DATA Soils Rating i~n AbSOrption Strata Date Instal ~d /d ~ Width of Field ~ ~) t~Jt ~h-- ,% Square Feet of Absorption A~ea Depression over Field (Y/N) Results of ~st Ade~a~ ~st ~/~ ~ Separation Distan~ fF~ ~so~ption Field: To ~te~-Supply ~11 [20' To ~o~ty Li~ To Building Foun~tion /,j~ / To Existing or ~ndo~d System Lot ~/~ ; ~ Adjoining ~ts > .5~] / To WateF Main/~vi~ Line ~Q~ 4 To ~t~(if pre~nt) ~/~ To StFe~ond~ke/~ MajoF ~aina~ C~ ~/~ To ~iveway, Pa~ki~ ~ea, ~ Vehicle Sto~a~ ~ea ~ ,~f',~//~ Type of System Design Length of Field Z~ Depth of Field Gravel Bed Thickness Standpipes P~esent (Y/N) Date of last Adequacy Tes~ De LIFT STATION A J07' Date Installed Size in Gallons "Pump O~" Level at High Water Alarm Level at Tested for ElectFical Codes (Y/N) Dims ns ions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. ~ets MOA Conments ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ confo~msd to all MOA HAA Guidelines in effect on the date of this inspection.~~ .If.~,~_6~-~'~ Signed~~ ~z~ ~ Date /!/4~'~ ~'/ -~' ~ ooe..~.~. //~., % JOHN . 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