HomeMy WebLinkAboutT15N R1W SEC 18 LT 104 E2T15N RlW 18 Lot 104 #051 - 172- 25  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- A~ehorage, Alaaka 99B01 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL IN$PECTION REPORT NAME iPHONE i [~'MEW · --~ f--I UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~~ Manufam~er ~ M~mria~E~~ No, of compartmen.~ ' ' ~ Manufactu., ......... ~ / m Material Liquid capacityin gallo.. ~l~-e ' I Foundation3./t Neam. lot ,ln~7 ,~ PERMIT NO. ~ ' No. of lines I Length of e~ Tetal'lengthpf lin~s._~ = Trench wldt~o inch. ~ Top of til~ to finish grade / Material beneath tile TO~I effective ab~tion~a  Type of ~lb Crib diam~er ~ ~ ~ T~e} effecti~ e~ormion area ~ DISTANCE TO: ~ Ol~s Depth Driller Dbm eolot Jino PERMIT ~ ~ DISTANCE TO: Bu[Iding ~t~o~ ~er ~ ' ~ / ~c ~k Abl~tlon OTHER P~PE MATERIALS ~ SOIL TEST RATING Z/O ~/~ IN~TACLER PERmiT NO. DEPflRTMENT '"" HEFILTH fiND ENVIRONMENTRL ~OI'ECTION 825 2~-4720 ( 8207~8 > flPPLIORNT :.CHt"IIDT BROS LOCflT I 0N LEGRL TiSNRIN Eld2 Li04 ~L~ ~ LOT SIZE G94--29'79 40000 SQUFIRE FEET TYPE OF' SOiL RBSORPTION SY~'T'EM IS: TRENCH HflXIMUM NUMBER OF BEDROOMS SOIL RFITING <S~ FT/BR>= 210 THE REQUIRED SIZE OF THE SOIL flBSORPTION SM5TEM I$: THE LENGTH DIMENSION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRfllNFIEL. D, THE DEPTH OF' FI TRENCH OR PIT IS THE DI~TFINCE BETWEEN I'HE SURFFICE OF THE GROUND 8ND THE BOTTO~ OF THE E~CRV~TION <IN FEET). THERE IS NO ~ET WIDTH FOR TRENCHES, THE GRBVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRL, L PIPE fiND THE BOTTOM OF 'THE EXCRVRTION (IN FEET). PERMIT flPPL. ICRNT HFI5 THE RESF'ON$IBILITV TO INFORM THIS DEP8RTMENT DU~;ING THE IN5TflLLFITION INSPECTION5 OF flNV NELL~ flDJRCENT TO THZ~ PROPERT~ 8ND I'HE NUMBER OF ~E_IDENC, E5 THAT THE HELL WILL SERVE. ...... 'TI,{O ~,.: 2 ?-~ ~. f"~-'SF"EC1- ! ON,S: FIRE RE~U ! RED Bfl--KFILL. ING OP' tiNY ,_Ar:,IEH NITHOUT FINfiL IN_.FEcFION RMD flPPROVRL BY THIS DE;PRRTNENT NILL BE SUB,.I'EC'T TO PRO-SECUTZON. HINIMUM DISTRWCE BETWEEN R WELL RND tiNY ON-SITE SENflGE DISPOSRL SYSTEM 72; 100 FEET FOR 8 RRIVRTE NELL OR :LS~ TO 288 FEE')' FROM R PUBL'rC HELL DEPENDING UPON THE TVPE OF PUBLIC HELL. MINIMUM DtSTRNC:E FROM fi PRIVATE NELL TO fl PRIVRTE SEWER LINE IS 25 FEET RND 'TO R COMMUNITV SEHER LINE IS '75 FEET, OTHER REQUIREMENTS MRS' RPPLV. SPECIFICFITION!{. RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO IN~URE PROPER INSTRLLRTION. I CERTIFY THflT ~.: IRM FflMIL:[RR WITH 'THE RE'QIJIREMENTS FOR ON-~ITE ~EWER$ fiND WELLS fl2: SET FORTH 8M "FHE MLINICZP~LZTM OF ~NC:HORSGE, 2: I WILL INS'FFILL THE SVSTEM IN flCCORDRNCE WITH THE CODES. ;~: ~ UNDERSTRND THRT THE ON-SITE SEHER SYSTEM NR~ REQUIRE ENLRRGEMENT IF THE RESIDENCE I~ RERODEL. ED TO INCLUDE MORE THRN 3 BEDROOMS. ....... _ _ ................. [] EOIL$ LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION B2~ L. ~reet, Anchorage, Alaska 99501 264-472II SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION= "~ ) ~--' ~' 1 7 DATE PER FORMED: SLOPE SITE PLAN / 10 11 12 13 14 15- 16- 17- 18' 20- WAS GROUND WATER 4] ENCOUNTERED? 1~ 0 ~ O P E IF YE~ AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop , ~ PERCOLATION RATE ~ (minutes/inch) ii.er t A, Ne, TEST RUN BETWEEN ~ ~ FT AND ~ --_./FT CO MMSN ...~? ' -e~.~", ~ " ·.,... 72-008 (6/79) PERMIT NO. HUN I C I PRL I T¥ OF RNCHt'~RRGE DEPARTMENT [ HERLTH RND ENVIRONMENTRL JTECTION 825 ~L' STREET, RNCHORRGE, 264-47~0 ~L P~R~ · T ~PPLICANT _OCATION -EGRL RRTHUR J HRCKNEY NORTHERN ~IGHTS ~50~ 277-1922 LOT SIZE ~9~ SQURRE FEET ~INIMUM DISTRNCE BETWEEN R WELL AND' RNY ON-~ITE SEWAGE DISPOSAL SYSTEM IS [00 FEET FOR R PRIYRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING JPON THE TYPE OF PUBLIC WELL. ~INIMUM DISTRNCE FROM R PRIYRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. aELL LOGS J~RE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS 3F THE WELL COMPLETION. 3THER REQUIREMENT~ MR~ RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLL~TION. PERN I T EXP I RE~ DECEMBER I CERTIFY THRT l: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICZPOLI~J~ OF RNCHORRGE. ................... V4. 0 WATER STA11C limed -.///d7 ,,,,)- GALL PER HR KIND OF CASING WfaJ__ DRILLIER~3 NAME SULLIVAN WATER WELLS P.O. BOX272, CHUGIAK, ALASKA99507 · TELEPHONE688-27159 ; ..: · .... /,. ~' .~...~ ..~ ~. . , ,. OWNER OF LAND , "' .... ~,.,../ ~DRES5 ~'~,~ ~ STATIC LEVEL OF WATER DATE- S~ed ,//?' PE~IT NUMBER KIND OF C~ING KIND OF FORMATION: From r~"l FLto .'/ Ft. "~' /~ ~/,~r~~ '~ From ' Ft, to ,Ft. · ~'" :'" "~ ' ~"/' ~'~-~',,x.~-~. From Ft, to ,Ft. F~ ...~ Ft. to ~ '/ ~. ,.~'~ ~'~' '~ ,,~/ From ~ · Ft. to~Ft. ,~',:,'~-~ ~ '~" ~'' ~ /. ~"~ ./.,~: ,- F~om Ft. to Ft. From "?,i,~ ~. to ' F-~ Ft. /~'~ '~' -~ '"~>'"' ~' ?/'~:: ~ From Ft, to Ft, / Ft. to ¥'-"~..-~ ~'~...r From, Ft. to, Ft. From Ft. to ~. ~ /.., ~,./g? ,,' ~.~ ~ ~/.o ~,: ~. From ~ Ft. to Ft. F~Ft. to Ft. . ~'~) '~ r-',,=~ ~ t",':~= © From ~ Ft. to~.Ft. From Ft. to~.Ft, From ~ FL to , ,, Ft. From Ft. to.~.Ft. From Ft. to .Ft. From Ft. to Ft. From Ft. to Ft. From __ Ft. to Ft From Ft. to Ft. From Ft. to Ft From Ft. to Ft. Ft~m Ft. to__.Ft. , From Ft. to Ft, From.__FL to Ft. From Ft. to.__Ft. From Ft. to Ft. From__Ft. to Ft. From Ft. to Ft. , FroJa FI. to FL MlSCL. INFORMATION: DRILLER'S NAME __ - " MUNICIPALITY OF ANOHORA~E ' ' ' DEPARTMENT OF HEALTH & HUMAN SERVICES DIVIEION OF ENVIRONMENTAL SERVICE, CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL " OF ON-SITE SEWER AND WATER FACtI"IIY ' 2~1-4744\ Application' Date Au_ot~t 22. ]gRR GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) : '";'.,..""" ", ' (a) Legal Description (include lot, block, subdivision, ss~ion, township, range) ~; 5or 104: Sectio~ 18; T15N~ R1W Location (address or directions) .N:l~ian ;,one (b) Prope~ 9Wrier Mailing Add(.; "#39941 (c) ' Lending in~fi{ution. ":.: Mailing Address (d) Telephone: Home Telephone Business Rear Es~te Co~pany and A~nt Addr~s 1~ ~nbe~i~d ~i~t Suite 201~ ,~gl,e ~i~T, ~ Telephone.. , 6~200 99577 (e) Mail the HAA to the followino address: or: Check here ~, if hold for pick up. List contact person and day phone number below. S & S ~NGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River~ Alaska 99577 .. TYPE OF RESIDENCE Single-Family ~[ Number of Bedrooms' WATER SUPPLY Individual Well ~] Community [] Public [] Note: If corem unity well ~ystem, must hqve written confirmation from the State Department of Environmental Conservat on attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~ Public r'] Commu~ity~, .l~.~la!ng Tank I-I Note: If corn munity well system, must h~ve.W~.itten confirmation from the State Department o~ Environments Conservat on attesting to the legality and status, .,'..' ' Page 1 of 2 ?;-~?s IRev 8,861 Front ,ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' As certified by my seal affixed hereto and aa of the validation date shown below, I verify t~at my investigation of this Health Authority Approval shows that the on. site water supply and/or wastewater disposal system is safe, funcfiona~ and adequate for the number of badrooma end type of struoture indicated ,~ereJn. 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 weatewater disposal system is in compliance with all Municipal and 8tats codes, orclinances, and regulations in effeot on Telephone the date of this inspection. Name of Firm S & S ENGINEERII~ Address z,~ue,, ' ,' ~:,-. ' ,- -~. ...... Date _ E~Ie Rlver~, Aladca 99577 Approved for ,,~ bedrooms by - . Approved ~' -~ Disapproved Conditional Terms ~f Conditions App'.oval CAUTION The Municipality of Anchorage Department of Health and Human Servloes (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph $ above by an independent professional engineer regfstered in the State of Alaska. The DHHS does this as e courtesy to purChasers of homes and their len ding Institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not co~duct Inspections o~' analyze data before a oertificate Is issued. The Municipality of Anchorage ~s not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72.o~ (~v ~l eaek M.I~I~CIPALITY OF ANCHORAGE (MOA) ,~C~ "' ~J'H~l~"l~tl"l AUTHORITY APPROVAL (HAA) C_.If~CKLIST- FEBRUARY 1984 Legalo.c . WELL DATA Well Classification ~ i--.~ ~ V' '~ C:;::>~-~.- If A, B, C, D.ErC. Approved {Y/N) Well Log Present ~'~N) ~/ Date Co/npleted ~tt~d~-" Yield Tot~ ~pth ~ ~ ,. Ces~ to ~ ~ De~h ~ Grouting Static Water L~ ~ / Pump Set At ~sing Height Able Ground ~" ~nitary Seal on C~ing~) Electrical Wiring in Conduit~N) ~ Depression Around Wellh~d (Y~ ~ration Distan~s from Well: To Septic~ Tank on Lot ~ ~ t ~ ; On ~joining L~s To Nearest Edge ot Absorption Field oq L~ ~ ~ I~ ; On Adjoining Lots To Newest Public Sewer Li~ [~~/~ To N.rest Public ~.r Cl~nouUManhole ~ To Nearest ~wer S~ice Line on L~ Water~HeColle~edby ~ ~ ~1~~ ;Date Comm.n 3- B. sEPTIC/H"OCIHNC~ANK DATA Oate Installed ~ '-'~0-~-''' Size Standpipes~N) "/ Air-tight Caps~i~/N) Depression over Tank (Y~i~ Pumping/Maintenance Contract on File (Y/N~i Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticJHoM~ank: To Water-Supply Well ~ ~ I''r TO Property Line .!~ C> To Water Main/Service Line Course ..~'~ c::,~:~ ~-~ No. of Compartments '2.- Foundation Cleanout~N) ~/ I~/;ate Last Pumped ? -- t~-~ ~.8 ; for p3/.~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~ I To Stream, Pond, Lake, or Major Drainage Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ I ~ ~///l'.-~-.-~ Type of System Design Date Installed ~ -- ~. c~- q~"/..~-- Length of Field Width of Field .~ ,~ r Depth of Field Square Feet of Absorption Area Depression over Field (Yit~ Rseuifs of lest Adequacy Test Gravel Bed Thickness Standpipes Present~:$~/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ~5/,~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments on I I ~ I.~. To Property Line "33~' ~ To Existthj~ or Abandoned System ; On Adjoining Lots / To Cutbantk (if present) ~.X//&. .... "Pump On" Level High Water Alarm Level at Testea for Electrical Codes (Y/NI Dimensions Manhoie/Aceess (Y/N) "Pump Off" Level at Vent (Y/N) udng Commen~ Adequacy Test. Meet~ MOA ** Cheek Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M/CAnnel HAA guidelines in effect on the date of this inspe0t on Signed ..... Date /~.///~ ' Compa~)~3~ ~ ntver Loop noad Ne, (~f~A NO. ,")~Y'"" ~ ~ " D,te of Payment ~'-/-~::: ~ Amount: $ / ~0 ~ 0 Page 2 of 2 & GEOLOGICAL LABORATORIES OF ALASKA, INC. ,or~ De~eo~e(l '" Sea 3ampl. KeMxks Above Hot Analyze~ ~,T-Loae T~m, ~ze&te~ The~ CHE~CAL & GEOLOGICAL LABOIL4TORIES OF ALASKA, INC. ,~ TELEPHONE (907) 562-2343 5633 B -~treet \Drinking water Analysis Report for'Total C'oliform Baotena TO BE COMPLETED BY WATER SUPPLIER I I I I I I ~2F--PRIVATE WATER SYSTEM ,~' Hem. 'S & S ENGINEERING 17034 ~gle River Loop badge. 2Q4 Phone No. City State Mo. O~.. Year SAMPLE TYPE: ~ ~. ~taC-Routlne ~ [] CheCkwith labSampleref, no.(far murine sample ) i~ Special Purpose Zip Code [] Treated Water [] untreated Water TO BE COMPLETED BY LABORATORY .~ysIs shows this Water SAMPLE to be: ~atlsfactory . [] Unsatisfactory [] 8ampfet°O long In transit; sample should not be over aO hours old st examination to Indlo~te reliable results. Please send new sample v~e epeolal delivery mail. Oefo Ro lvod 0 Time Reoelved. ' l / dO Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref..~ No. Result* ~,- Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALY$18 RECORD Membrane Fitch Direst Count ~'/~ / Verification: LTB - 8GB Membrane FJ~ul]~--.~ ~ ' /'~ Final Reported By ~c"~~,~~'~ .Date Time: //'-5"~ a.m. TNTC = Too Numberous To Count OollformllOOml Coliform/lOOm] OB = Other Bacteria APPLI~' NT FILL;S'OUT uppER HAr ' ONLY Buyer A~re~ Zl~ ~o Ratty Co, & ~nt '~ Phone ~d~ss Zip ~e Ty~ of ~ Multiple Faml~ No. of ~dmo~ ~ Other ~dlvld~l A~AGH ~LL LOG. A ~l Icg Is ~qulred f~ ell ~lla driB~ N~ Ju~ ~ ~mm~lty For wells elll~ prlo~ ~o lha date. gl~ well depth (afls~h ~ If available). Se~r Dl~al D HoldlngTank · -., NOTE: ~E INSPE~ON ~E MUST ACCOMPANY EACH R~EST BEFORE ~G~SING CAN BE INITIA~E~ 4/'- Time Time T~rne Time Date Date Date Da~e Inepeclor Inepe~lor Inspector Inapeotor ~ NOI~ /,/-~,,.- ~' '~ ,'"'~ ( ) AP~VED ~D~OM8 *CONDITIONS OF ~P~VAL ~lls Rating Date ~m In,ailed ~ Well TO ~sorptlon Ama Well Log R~elved 3anuar~ 21, 1983 Arthur 3. ~lackney 50S ~. ~orthern Lights Blvd. Anchorage, A~ 99503 Subject: T 15~ R1W Section 1~ Lot 104 gast ~/t a~ Approval [or the individual sewer and water facilities cannot be granted until the follo~inq items have been completed: o The depression or pit around the well casing needs to be /illed with i~pervious type soil so that it elopos away ~rola the wall casing. Exposed electrical wires to the well head are in violation of the ~unicipslity o~ Anchorage codes and must be encased in conduit. The water analysis ~epor~ needs to be submitte~ to this o//ice from the Che~ ~ab~ 5633 B Street, /or our review, * You need a well per. it, sewer-only. Per~i~ #820768. Bring a copy o[ ~11 log to ou~ off,ce. Please notiiy this Department for a reinepection when tho note~ disc~epancies have bs~n corrected. If there are any furthe~ questions, please call this.o/fl~e at 264-4720. Sincerely, Aaao~iate Envi~on~ntal Special'!~t