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Home My WebLink AboutT15N R1W SEC 18 LT 215 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 L.~ PHONE ~NEW ViAl LING ADDRESS LEGAL DESCRIPTION LOCATI%~; ~ ~ O~ S ,~ NO, OF BEDROOMS Absorption area ~ ~ O0 ~ ~ ~, ,, DISTANCE TO: Iwell /¢¢1 I ¢¢' Dwelling , PERMIT NO. ~ ~ Manufacturer No. of compartments~ Liq. capacity in gallons Inside length Width Liquid depth & ~ DISTANCE TO: ~e~l Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~= DISTANCE TO: Well /~, Foundation~/ Nearestlot~ , PER~o No. of lines / Length of each lifle Total le.~ ~l~nes Trench width Distance~7~. ii.es ~57 --~ ~/ ~O inches ~ ~ ~ Top of tile to finish grade ' Material beneath tile Total ff ctlve absorption area Length Width ~ Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO, ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING APPROVED , DATE LEGAL Rev, 3/78) PERMIT NO. ( APPLICANT NORTH STAR CONSTRUCTION LOCFITION '~' ' " '= TYPE OF SOIL ABSORPTION SYSTEM PO BOX 41~ E. R. LOT SIZE TRENCH 688-2~94 45468 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: r;' E ~ T I"~= 6 LENGTH= ~";_~ [:i R I--] ',,,,' E L [.-', E P T H = ~ 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 OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RED SEPT I C TR~4K $ I ZE= 1~-300 6RLLO[-~S 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. ......... Tb~O (2) I~-~SPEOTI~mP4'.~ ~RE REQUIRED BACKFILLING OF ANY SYSTEM WITHOUT FIN8L 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 R PRIVATE WELL OR 250 TO 208 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND 'f'O Ft COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS M~Y APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERMIT EXPIRES DECEMBER ~i., 2980 I CERTIFY THAT i: I ~M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS ~ND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INST~LL THE S~STEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS, RPPLIr~ANT NORTH ~TRR CONSTRUCTION CO. ~-~ ~ /, O & E ENG,NEERING & DEVELO, MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: SOIL LOG Mailing Address: BoX Legal Description: ~d~" ~.~/--~-x ~,~-C. Earl Ellis 688-2280 Tel. No. ~' Depth (feet) $oll Characteristics 7__ 8 9__ 10 11__ / J PLOT PLAN 12__ 13__ 14__ 15__ 16__ Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ Comments: Performed by: PERC. TEST No /~ If yes, what depth Drain Field Date: 825 "L' STREET ANCHORAGE, ALASKA 99501 (9071 264-4111 GEOF~GE M, SULLIVAN, OEPA[~TMENTOF IIEALTH AND ENVIRONMENEAL PROTECTION December 18, 1980 TO: Whom It May Concern SUBJECT: T15N R1W Section 18 Lot 215 Ralph/Carmon Moody Property Public sewer and water facilities are not available to the above subject property, making it economically unfeasible to connect to these facilities. This property is maintained by an individual/community well and on-site sDwer system/public sewer at this time. If there are any further questions, please call this office at 264-4720. Sincerely, ./ '~ . Les N. Buchholz, Senior Environmental Specialist LNB/ljw cc: File SWP/060 PERMIT NO. ]'.; C: I RL I ]-"~'~ OF" R~'~(::~'"" DEPRRTMEN'F OF HERLTH FIND ENVIRONMENTRL , ,(OTECTION 825 "L" STREET, RNCFIORRGE, RE. 9950fl. 264-4728 8lOEwi2 > RPPL. I CRNT L. OCRT I ON LEGRL R W MOODY T~.SNRiW ~] 18 LOT 215 BO'?, 140 KLONDIKE CHUGIRK LO7' SIZE 688-'.2658 60000 SQLIRRE FEET MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS t00 FEET FOR R PRIVRTE NELL OR ~50 TO 200 FEET FROM 8 PUBLIC NELL DEPENDING UPON THE TVPE OF PUOL. IC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNIT'¢ SE~,.IER LINE IS 75 FEET. WELL LOG~ RRE RE6!UIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN gB DR'CS OF TNE NELL COMPLETION. OTHER RE6:!UIREMENTS MRb' APPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS ARE RYRILRBLE TO INSURE PROPER INSTRLLRTION. C:ERT I F'¥ TFIRT RM FRMILIRR P.II"r'H TFIE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTN B"r' THE; Mt.INIC:IPRLIT"r' OF RNCHORRGE. HILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~PPLI CRNT R~ ~ ~ V4, 0 0 · D i~ ¢£ U'~ ,G~Q~,~-8 !~i r~.ELm'e~n t R L'qPrvic', A __.__ P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~3~ \ --~ ~'\- ~,f~L 1. GENERAL INFORMATION Complete legal description BLM 215, Section 18; T15N, R1W, S.M. Location (site address or directions) 19515 Spruce Crest Eagle River Property owner Richard Rochin Day phone 688-3006 Mailing address I~ ~-¢~/--~ ~,I~,~/¢~ /_~¢,-,~1,':~/~ ~wl~C=7 Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well X Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer x WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. ,--Z~ ~<?'~ During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot ~/D- Block of ,~5~.'f /~-7~/~/~'/~/~' ~f>~, Subdivision, the well's productivity was determined to be ~ ? . gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a ~ bedroom residence is~-~/ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Log present.N) Total depth If A, B, or C, attach ADEC letter. Sanitary seal (~'N) '~ FROM WELL LOG Date of test Static water level Well flow \ ~L~ Parcel I.D. ADEC water system number "'--' Date completed L~-\~- ~d~'7'~ Driller Cased to ~ ~ Casing height Wires properly protected~N) AT INSPECTION SEPARATION DISTANCES FROM WELL TO: \c?c'~ A~ ; On adjacent lots \ ~"~L~ Jc ; On adjacent lots Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer manhole/cleanout Sewer service line ~ Jr" Petroleum tank t-~ /,~- WATER SAMPLE RESULTS: Coliform ~ Nitrate ~ ' ~ Other bacteria Date of sample: ~ ~ ~'~ Collected by: ~ ~ ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed '~ -~?t --' ~ Cleanouts ~)~/N) ~t~ High water alarm (Y/N) Date of pumping Tank size '~ ~ Compartments Foundation clea no utc[t~:;~l) '-f Depression Alarm tested (Y/N) ~- ~ ?'~ Pumper ~-"~ "'-~'~-,J ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ ~::)~ To property line ~ Surface water/drainage On adjacent lots Absorption field Foundation Z~z~cl Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE PROaECT: /5/_./~ Z[5~ ) 17034 Eagle River Loop Road Eagle River, Alaska 995?? '* !diLL FLOW TiS! DATA SHE[T" LOCATION OF WELL (Legal Descdption):. r~-I~l~ WELLDEPTH; ~ c~ FT. CASING: ROBERTA. SNAFER FT. DRILLER: CIVIL ENGINEER 694 2979 DATEOF EST:. SCREEN: DATE DRILLING COMPLETED: ~- ~ 'c~ - ~ STATIC WATER LEVEL (Top of Csslng): "~'~ FT. DATE: EL&P~ED TIME SINCE DEPTH TO DRAWDOWNI PUMPING CLOCK PUMPING STARTED/ WATER, FT. RECOVERY RATE~ OPM REMARKS TIME STOPPED, MIN. /O:~ 0 ~ff' (swl) 0 0 Start ?, ~ ~ 15 20 I .~ ~ O~ 6mm (1 hour) ~ ' /: 5~ 120(2hours) ~/ 5~ ~; 15~ 150 ~/ Gl 180 (3 hours) 213 ~ ~ OD 240 (4 hours) ~' ~ ~30 4:o~ .~4~ . Comments: ~)~LL "[IELOS O,q~. ~1/~ Old THE Au6g. B~, THiS YIEL~ 15 SuFPIC..IE~J5 F'o~- /A, .~ ~p~ HORE, Flow is not Guaranteed Subsequent Variations Can OcCur. CttEMICAL & GEOLOGICAL L4BORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B S'FREEI' ANCHORAGE, ALASKA99518 TELEPHONE (907) 562-2343 FAX: (907~ 561-5301 Chemlab Re£.l 92,6017 Sample t 1 Matrix: WATEE Client Sample ID PWSID Collected ~ecetved UA OCi 28 92 { 12:15 h~m, ~? 28 92 { 16:00 hr~, Client Acct :~NSENG? BPO$ : POt :NONE RECEIVE Analy~la Completed : OCT 29 92 Send Bep¢=t4 to: Laboratory Supe~vlzo~ ,~TEPHEN CEDE i)S & S B.leeeed By: ~ ~ /~ Paramot e~ ~e~ul t~ U~lt~ Net b~ E) lcd, able [l~ts NITRATE-N ND(C ICJ ~fi Z?A 353 2,/3~0.0 10 Sample ROU?INE SABLE COLLECTED BY: RAY. I Yest~ Pe~fo:mod See Special Inet:uction~ Above UA-Onavallable ND- None Detec%e4 "~se Sampll ~emalkm &bore NA- Not Analyzed LT-Le~ ~han, GT-Ozeatez Than Drlnklrtg Wa'mr AnaJysJn Repmi for Total Coliform Baoterta TO ~ COMPLETED BY LAOORATORY TO BE COMPLETED BY WATER SUPPLIER . ,,,.,. ,,^=E, ,,--,M .... , LI.J___.L_I.. LJ ~. pRtVATF. WATEn SY~.TEM SAMPLE TYPE: Treated Water Unlrealed Water ~ I~ouklne [3 Check .'~ample (for routine wilh lab tel ne. . ............. [] Special Purput~8 .~AMPLE Time Cellerted No. LOCATION 0ollo¢C~ Dy READ INSTRUOTION~ BEFORE COL L P'C. TI.!?IO SAM PJ__E~ AnaJy.~i~ ohow'~ thio Wal,~r 9AMPI, ~ ~ampre loc k>pg in transit; ~ampJe should not [~ over 30 hours old at examination to indicate reliable rosulls, Please send nnw ~mpl~ vin ~e;lnl d~llve~ m~t. Time Hecelvod ...... ]..~ ~ h;lolfll~l ?~'~thod; M~mhrann ' Ne. otcobn,e$/tO0~ I, BAC'rEI~IOLOGIOAL WA'I ER ANALYTIC REOOI,1D Mnmbraoe Filter: __C~) .... Collform/lO0 mi BOB Fee,~l Cotilorm Conflrmullon THTC = Too Numerous To Count OB -- Other Bacteria PART ONE OF TWO KF..ttAINDI;;P Tn FOLLOW C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ ~,¢_~ Length ~'~'~ Width 'Z.- .~'~ Total absorption area Depression over field (Y~ ~-~ Results ~;~s-Tf a i I) Peroxide treatment (past 12 months) (Y/~ Soil rating ~"~"¢"/~'z~ System type"'-"--~'~ Gravel thickness ~¢' Total depth Cleanouts presentdC~N) Date of adequacy test for '~r--~ ~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ ~Pc~t J¢ On adjacent lots 1[ ~ ~ J~ To building foundation On adjacent lots Surface water Curtain drain ~ Cutbank Property line To~xisting or abandoned system on lot T~/A Water main/service line 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 effect on the date of this inspection. Signature S & S ENGINEERING 17034 Eagle River Loop Road No. 2~ ;n_al~ River~ Alaska 99577 Engineer's Name Date HAA Fee $ Date of Payment Receipt Number 72-02S (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number Name of Firm Address Engineer's signature STATEMENT OF INSPECTION BY ENGINEER 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 application 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. s & s ENGINEERING Phone 17034 Eagle River Loop l~oacJ J'Jo. 5,04 Eagle River, Alaska 99577 Date DHHS SIGNATURE ~'~ Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 DHHS 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 #21 DAtE RECEIVED TiME INSPECTION APPOINTMENTSTiME TIME~ '~------{~' DATE DATE DATE INSPECTOR INSPECTOR I NSPECTO~r~' ~IUNJCIPALUY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H~.%TH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE{~ENTAL 825 L Street - Anche~a~e, Alaska ENVIRONMENTALSANITATION DIVISION JAN 1 g Telephone 2~4-4720 ~~'~mC~ ~ '~'~ ..... DIRECTIONS: Complete all parts on page 1. Incomplete requests wi I not be processed P ease allow ten 10 days for processing. 1. PROP~YOWNER ~ PHONE MAILING ADDR~S ' MAILING ADDRESS 3. 'LENDING INSTITUTION ] PHONE MAILING ADDBES8 4. REAL. R/AGENT / ~ ~ PHONE MAIL'ING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYIYE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four J~] SINGLE FAMILY [] Two [] Cive [] ~ULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY INDIVIDUAL' [] COMMUNITY [] PUBLIC UTI LITY E. SEWAGE DISPOSAL SYSTEN1 INDIVIDUAL/ON-SiTE** [] PUBLIC UTILITY [] Other ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that aate, give wm depth (attach Icg if available.) .YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 82~ L. STREET ANCHORAGE. ALASKA 99501 (907) 264-4111 GEORGE M, SULLIVAN MAYOR DEPASTMENT OF HI~JALTH AND ENVlr~ONMENTA L PROTECTION January 23, 1981 Ralph/Carmon Moody Box 140 Klondike Street Chugiak~ Alaska 99567 Subject: T15N R1W Section 18 Lot 215 Approval for your individaal sewer and water facilities cannot be granted until the following items have been completed: (i) The water analysis report needs to be delivered to this office from the Chem Lab, 5633 B Street, for our review. A permit needs to be obtained for the drilling of the well on the property. A permit was not taken out for the well. A well log needs to be submitted to this department. If there are any further questions, pi. ease call this office at 264-4720, Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: National Bank of Alaska Pouch 7-025 99510 Dolores Oesau % Red Carpet - Greatland Box 633 99577 APPLI' ,NT FILLS OUT UPPER HA 'ONLY Buyer ,,J' ( ~ Zip Code Address Phone Type of esi~nce ~ ~ ~ Multiple Family No. of Bedrooms~2 Water Su ly ual WELL LOG. A w~l log Is required for all wells drilled {!ncc June 1975. ATTACH ~ Community Fo~ wells drilled prior to that date, give well depth (attach log If available), ~ Public Utility Sow~6sa~ ~ Individual Year Individual Installed: ~ Public UtBIty When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date D a t e~/~/~4 Inspector Insp~tor Insp~tor Insp~tor ~' ~ APR "Municlpall~ of "Dept. ~P~ROVED BEDROOMS ~ *CONDITIONS OF APPROVAL Enviroii~e~ ( ) DISAPPROVED ) CONDITIONAL APPROVAL* ' ~ .... Soils Rating Date ~wer I~s~d Well To Absorption Area Well Log Received ~~ Well to Tank Septic T~k Size SANITARY PUMPERS P.O. BOX 346 EAGLE RIVER, AK 9957~'. 694-2408 Date- ............. U~'O ......... t OVER 30 DAYS--lY~% PEK MO_, __ __ ~I~RM~® S T A T E M E N T 8K 882 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEOROOMS . [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY ~'__ ~ Connection Verified INSTALLER []Sel~t~l~ or []Holding Tank Size: ~ ~.'~-'~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER ,/~ _.~ 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: //,~.,? 4) I Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)