HomeMy WebLinkAboutNORTH SLOPE BLK 1 LT 4North Slope
Block 1
Lot 4
#050-511-31
DE 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
S6 vIs TO SEPTIC ABSORPTION
Address /}IcFWELL
TANK FIELDWELL
2.. 6A(i.t P-/VLF1Z RD A(-, 2tvdfc, 9AK
Phone(s) Permit No. No. of Bedrooms
Z7&- S_�Z7 B(ov,3o$ 1 3 app I /ot> t
LEGAL DESCRIPTION LOT LINE p/ ,F / / r
/0
Lot Block Subdivision 'f"
`� I Nva-•tN SC,oPc �, FOUNDATION ILr
Township, Range, Section y3i
® -- J i y J� i As -BUILT DIAGRAM (Show location of well, septic system, property Imes, foundation,
I LI u R IE 1 driveway, water bodies, etc.)
TANKS
ASEPTIC
❑ HOLDING
Manufacturer
Capacity In gallons
Material
No. of Compartments
STC-_ r-_ I--
L
TYPE OF SYSTEM
❑ TRENCH ❑
BED 1- W. DRAIN ❑ OTHER
Depth to pipe bottom from
Total depth from original grade
original grade
FT
U
1
FT
Fill added above original grade
Gravel depth beneath pipe
FT
Z
FT
Gravel length
Gravel width
Z Co
FT
5
FT
Total absorption area
Distance between lines
O
SO FT
p
FT
Number of lines
Soil rating
Pipe material
Z
IZ
SOFT
ASTM &303v
InstallerDate
J#4 SO T T
Installed
WELLS
C")'PRIVATE ❑ OTHER (Identifv)
Classification (A,B,C) Total Depth Cased to
FT FT
Installer Date Installed:
REMARKS:
G N T I IL& F I Gc..'1`> Gv �EJL431> w I TH
ISR B 196X certify that this
Municipal and Steri iplMjl pn 1W1 IQC)J; 7-
7
scale: r =So•
Inspections Performed by:
_� PM
Date.
spe ionwe performed according to all
� 7
�/�� d
Health Department Approval: Date: Z _
72-013 (3/85)
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MUNICIPALITY OF NCHORAGE
DEPARTMENT OF HEALTH AND EN'JIn�..ANTAL PROTECTION
825 L STREET, ANCHORAGE, A.K. 9951VIi
264-4720
ON--WT1= 5E VIE7R PERI; I T
PERMIT NO; 0.6073 8 ENGINEERED DE: iGN1,4y 7774
DATE 16SUEN 08125'06
ADDREu;;s 2732 EAGLE RIVER RD,
EAGLE RIVER, At, 99577
CO•`dTACI PHH'r•'.E: 276-5727
LEGAL DESCRIP: SUBDIVISION; NORTH SLOPE I1 LOT, 4 BLOCK. 1
SECTION: 72 TO{)NSHIN 14N RANGE, HE
LOT 9110 2.451BA (S1 FT, OR ACRES)
certify that:
1. 1 am familiar with the requirements for on-site suers and V4e115 as set
forth by the Municipality of Anchorage (HOA) and the State of Alaska.
2. 1 will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
i will adhere to ail MGR and State of Alaska requirements for the set hack
distancc5 f!'om any existing well, wastewater disposal system or public
sewerage system or, this or any adjacent or nearby lot,
IF A LIFT STATION IS INHALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PEP "T AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPRO'r'Ei ;THOU. AN ELECTRICAL INSPECTION REPORT; AtJ➢ {3} THE
ELECTRICAL WORK {'_ T DE DO I B A LICENSED ELECTRICIAN.
SIGNED --------------- DATEa b
-- -- - ---�z -- --
",-PLICHNT: . VEV 1/E / &S
I SUED BY
--A�------- - ----<- �__ DATE:
Ll
31VOS
1 (29 - it /
co
Ll
31VOS
1 (29 - it /
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
1 1
PERFORMED FOR: �'GV fi. ^ �yL-t DATE PERFORMED:_ -7—$O � Q�
LEGAL DESCRIPTION: 1_—L >? ND._SLi7PtZ� Township, Range, Section:
,g,Fp-r�jd ,� w OlZG�O�/J1�.5 SLOPE SIT PLAN
O{t�rb+J1c-5I
2 Y
3 e
v
4 0
C c e'
5 � J
6
7
o
8-
9 9
10
11
12
13
14
15
16
17
18
19
20
e4" 2-S-1 *L-- .
(12-419 C1 -* 61, ">:r
W krvV
WAS GROUND WATER �,,
C%F 001 ENCOUNTERED? 6
S
IF YES, AT WHAT f L
DEPTH? O
P
E
Depth to Water After
Monitoring? S Date:
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
(o
TEST RUN BETWEEN FT AND + FT
COMMENTS
S & S ENGINEERING
SR B 196X
PERFORMED BY: {� 99j
ACCORDANCECI�THEALL SSTEATTE AND MUNI�IPAL GUIDELI
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
IN EFFECT ON THIS DATE. DATE: �/� AF -6
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES °^
825 "L" Street, Anchorage, Alaska 99502-0650 04
s
SOILS LOG — PERCOLATION TEST
\�(n(/PERFORMED FOR:T� r l�-E. DATE PERFORMED:
/rt•,` LEGAL DESCRIPTION: L4 IPA - 01), ask -Opp, Township, Range, Section: -r%4tZ g -4t
DE,PTW, 34AG SLOPE SITE PLAN
2
t.. ntZbA-r-��Gf
L m
3-
4-
6
6
b 4o
7
�� Q
8
W�
Q
9
" •o
10 A: WAS GROUND WATER
ENCOUNTERED?
11 4,pS
IF YES, AT WHAT Af L
DEPTH? V O
12 E
4+
13
14
15
16
17
18
19
Depth to Water After I
Monitoring? 13 Date:"u �b
==Mmm�
20 -{ I PERCOLATION RATE 3� (minutes/inch) PERC HOLE DIAMETER a
cul TEST RUN BETWEEN FT AND + FT
COMMENTS
PERFORMED Gl� I r� lcg I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S I FFECT ON THIS DATE. DATE: �s O 6
72-008 (Rev. 4/85)
20 -{ I PERCOLATION RATE 3� (minutes/inch) PERC HOLE DIAMETER a
cul TEST RUN BETWEEN FT AND + FT
COMMENTS
PERFORMED Gl� I r� lcg I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI S I FFECT ON THIS DATE. DATE: �s O 6
72-008 (Rev. 4/85)
v t
•.. v .. . ..
January 10, 1986
P.O. BOX 0650
ANCHORAGE, ALASKA 99502-0650
(907}264-4111
T `1/nN C'7. L cc
DEPARTMENT OF HEALTH & HUMAN SERVICES
TO: Permit Applicant
Subject: Permit # 850548
Lot 4 Block 1 North Slope Subdivision
A permit issued by this Department for an individual well and/or on-site
sewer system has expired as of December 31, 1985.
Permits are issued on a calendar year basis by authority of Municipal
Ordinance. A new permit must be obtained from this Department for any
well and/or on-site sewer system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to this
Department for documentation of the installation and to close the permit.
If a private engineer inspected the installation of the on-site sewer system
the original as -built inspection report(three part form) must be sent to
this office for review and approval,and for documentation.
If there are any further questions, please call this office at 264-4720.
Sincerely,
Susan E. Oswalt
Program Manager
On-site Services
SEO/ljw
enc: Copy of Permit
M U p�������������� ���� ���m s�0���
DEPARTMENT OF HEALTH AND ENVIRONMENTALPROTECTION
' 825 L STREET, ANCHORAGE, AK 99501
264-4720
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
850548
08/29/84
STEVE DIKE
P.O" BOX 773695
EAGLE' RIVER, Al-:*,' 99577
276~5727
LEGAL DESCRIP: SUBDIVISION: NORTH SLOPE LOT: 4 BLOCK: 1
SECTION: 32 TOWNSHIP: 14N RANGE: 1E
LOT SIZE: 2"5A (SQ"FT" OR ACRES)
I certi�y that:
1" I am Familiar with the requirements f'or 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 thp design criteria o[ this permit^
3. I will adhpre to all MOA and State of Alaska requirements 4'c) r, the set back
distances from any existing well, wastewater disposal system or, public
sewer thi dj ce t or nearby l at.
SIGNED DATE:
APPLICANTSTEVE DIKE ` �
ISSUED BY ��� DATE:
^� - ~
ISSUED °____~~..�,~^-.~`~~~~~�~~_-�__- �-CM
-~�`-//`����-_
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
' DIVISION OF ENVIRONMENTAL HEALTH v
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY L)Lfkik1
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, sub ivision, section, township, range)
��y��.t
Location (address or directions)
(b):; Applicant Name Telephone: Home Business
Applicant Address Z; !P 5Z— - V-1 � fin• C_-
?n 0��
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder' Buyer ❑ ; Other ❑ (explain);
I
(d) Lending Institutiioon7 l t�yl�lr�% Telephone
Address 1_CZl�oa-22Wr
(e) Real Estate Company and Agent
Address
Telephone
(f) Idag the HAA to the following address:
17034 Eagle Rtyer Loop Rnarf 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single -Family Multi -Family ❑ Other
Number of Bedrooms 3
3. WATER SUPPLY
Individual Well 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 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 (1 v84)
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 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
17034 age RI.Yer Loop Road No. 204
Address Eagle-RWer, Alaska 99577
Date eZZ 7 ��
q.'uo•anr
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
MIINICIPAI-11 OF ANCHORAGE DI264-4720
ICES VISION
ENVIP.ONN njAESEF.V Legal Des iption: �� gl_I�•
A. WELL DATA
Well Classification r If A, B, C, D. .C. Approved (Y/N)
Well Log Present&l) Date Completed 8c� Yield �p13
Total Depth 1 0 ( Cased to 11nk Depth of Grouting l
Static Water Level Vo Pump Set At
u
Casing Height Above Ground I_ -t;;;, Sanitary Seal on Casingd7N)
Electrical Wiring in Conduit (VN)
Separation Distances from Well
Depression Around Wellhead (YF19T)
t t
To Septic/HoklTitj Tank on Lot + ; On Adjoining Lots 1
To Nearest Edge of Absorption Field onLot Ba) ; On Adjoining Lots X1-1
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by t, V -6" S • ; Datele (�I
Water Sample Test Results 1J 1 T RGiL.S
Comments
B. SEPTIC/NQ&DH+G TANK DATA
Date Installed I –1 Size 1 6>Cn No. of Compartments12—
Standpipes
Standpipes MN) Air -tight Caps 49N) Foundation Cleanout ON)
Depression over Tank (Y/ lOj Date Last Pumped L!�
Pumping/Maintenance Contract on File (Y/N) ; for
N
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/klelthiV Tank:
To Water -Supply Well 100 l
To Property Line
To Water Main/Service Line
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation I -L–
To Disposal Field J_ -�-
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design 12r—�f�n Ea A>
Date Installed 1� �ti''t., Length of Field k,
1 �
Width of Field `� Depth of Field
Gravel Bed Thickness
21
Square Feet of Absorotion Area `� Standpipes PresentON)
Depression over Field (Y/f
Results of Last Adequacy Test
Date of Last Adequacy Test r_)�
Separation Distance from Absorption Field:
(
To Water -Supply Well ��) To Property Line
To Building Foundation
Lot V
To Water Main/Service Line t
To Stream/Pond/Lake/or Major Drainage Course
To Existing or Abandoned System on
On Adjoining Lots `"r
To Cutbank (if present) f'
To Driveway, Parking Area, or Vehicle Storage Area'—
Comments _X rr3'f&(L�t
D. LIFT STATION
Date Installed .
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at ,j "Pump Off' Level at
High Water Alarm Level at I - Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** 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.
Signeds g, S ENGINEERINGDate r /ZZ
Compa} 034 Sagle River Loop Road No. 204
MOA No.
Eagle rvor, u 1
Receipt No. / V b [ o 6-2 j a �` b
-c /g
Date of Payment
Amount: $
� crY; �a4s^,i A.. �tsktiA
Page 2 of 2
C
72-026 (11/84)
1 1,
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID # 92-0040440
4
, ." !. , " "o
PH
CHEMICAL & GEOLOGICAL LABORATORIES OFALASK4., INC.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343
FEDERAL TAX ID # 92-0040440
1 ts
Iii
Trrilffirb l3ritting iwg
b,
DOC Co. dW
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
OWNER OF LAND
ADDRESSti-
LEGAL DESCRIPTION€
DATE. - Started Ended
PERMIT NUMBER
KIND OF FORMATION:
DEPTH OF WELL
STATIC' LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING *' c
From
Ft. to .'
Ft.
J'Ei^ss3 ` "'
_ From
Ft. to Ft.
From
Ft. to "_ ij
Ft.
J
` "
From,
Ft. to Ft.
From
Ft to -•> `.�
Ft.
From
Ft. to FL
From
Ft. to
Ft.
1 r+
f '°�".t. ?-;
_ From
Fl -to- - Ft.
tFrom
From
Ft. toC'
Ft.
Ft. 1() -Ft
From
Ft. to `Y
Ft.
Froin
Ft. Yo Ft.
From
Ft. to ;
Ft.
Frori
Ft.
From
Ft. toFb�
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to_�, �Fi9lyFgq�C
From
F - Ft. AOTF
From
Ft. to
Ft.
J9 O�
From
Ft. to
Ft.
From
Ft. to Ft `
From
Ft. to
Ft.
From
Ft. to -
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 FL From Ft. to Ft.
From Ft. to Ft. From Ft. to Ft.
MISCL. INFORMATION
t1RI1 ITR'.S NAME