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Home My WebLink AboutPREUSS #4 BLK 7 LT 10GREM'ER ANCHORAGE AREA BOR' =LIGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL /20 MANUFACTURER INSIDE LENGTH INSIDE WIDTH / UMBER OF OMPARTMENTS LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL tH'- FOUNDATION NUMBER OF LINES ~ DISTANCE BETWEEN LINES ABSORPTION AREA ¢~//(-"'/ SQ. FT. LENGTH OF EAC" LINE ~;~ O/ ~' 3 <:~ I DEPTH: TOP OF TILE TO FINISH GRADE ~.~i;~ MATERIAL BENEATH TILE IN. ABOVE TILE TYPE ___ CONSTRUCTION BUILDING NEAREST FOUNDATION-- LOT LINE--, CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH NEAREST SEPTIC SEEPAGE SEWER LINE-- TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTF~M /~o{, ~, ~ t~ SEWER LINE DEPTH: LOT SLOPE: REMARKS: ~ G.A.A.B.~ Form EQ-o32 2 A & L DRILLING COMPANY BOXgT, EAGLE RIVER, ALASKA 99577 · TELEPHONESg4-2588 OWNER or LAND ADDRESS LEGAL DESCRIPTION -'~,~q~f(~ DATE-Started-~ / ' ~':~-/ '7 Ended PE~IT NUMBER .Z~2 DEPTH OF WELL STATIC LEVEL OF WATER FT. I DRAW DOWN FT. __ // GALS. PER HR KIND OF CASING KIND OF FORMATION: '::" , ,) Or')/47fv4~r)/'y'f/¥ ~'~ From From "' .Ft. to Ft. ~ From ') Ft. to_I ~ Ft. ]'/~9 From From / 6, Ft. to / 3:' Ft. .~//~00 From.~ From tSq' Ft. to /o ~ Ft. ~:) ~b/~oo~d~f" From~ From_;~ , Et. to_c/t3 Ft._ - ~ Ft. to.__Ft Ft. to__ Ft.. Ft. to Ft. Ft. to Ft. Ft. to__Ft. Ft. to_ Ft. Ft. to Ft. Ft. to Ft. Ft. to_ Ft. Ft. to Ft. __Ft. to.__Ft. __Ft. to Ft. _Ft. to Ft. Ft. to__Ft. Ft. to__Ft. Ft. to Ft. Ft. to Ft. From_ From. From From _- From _ From_ From Ft. to Ft. to Ft._ Et. to Ft. Ft. to Ft. Ft. to_ Ft From From _ From From_ From __ From DRILLER'S NAME F'ERM I T NO. RPF'L ICRNT E,! I_L FOF.:EMRN LOF:FIT I AN D~V ID ~'i,/E ,~. R~NFII_D PLRCE LEGRL L:tO B7 PREIJSS SUBD 8:4. DEPFIF.'."FMENT 01-- HEFILTH FiND EN,,, IRUNMEN]'FIL 'PF.:GTE. CT I uN ,,:...d.o E. TIJ[:,CIF.: RD.., FINCHOF.'~FIGE., FIR "-~95Ef? B.--t E L_ L R f",~ [:, El H'-.! ---. "_:.::,-; ][ ]- E ':_:--; E B..& tE F:: F' E F-: ~-.t~ ][ ( ?'6E:t¢-]l ) GEN [:,EL E.F.:. LOT SiZE '-' "- ' YF..EN _.H T"r'F'E OF SO I L RBSORBT I AN =, T.:,TEI'I l S: ' "'' P :1.:_a. 60~3 S[.'.!UFtF..:E: FEET hlR;q l MLIM NUHE:EF.: AF BEDF.:0OMS ,:-:A I L F..HT I N a F]',.-"BF.: ::, = THE F.'.EQUIRED 'SIZE i-iF ]"HE SGIL FIBSORPTIAN S¥S'T'EM IS: i~" i3 F:': fa %-" E g ET.:, Fi F" -f Fi == [::, F-: F" l" H --- 12 b E ~"-a ~2.~ 1-' H = 'THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH CiR DRFiINFIEI_D. THE DEPTH OF R TRENCH OR PIT IS THE DISTFINCE BETNEEN THE SURF'RCE OF THE GROUND FIND THE BOTTOM ElF THE EXCFIVFITION (IN FEET). THERE IS NO SET NI[:,TH FOR TRENCHES. THE GRR',,,'EL DEPTH IS THE MINtMLIM DEPTH OF GRFI',,,'EL. BETWEEN THE OLITFRL. L PIPE RN[:, 'THE BOTTOM OF THE E',:.::CRVFITION (IN FEET). EITHEF.: R CI_FIS':; I OF.: II NSF RPF'RC',/ED PLFINT I"'IFI'T' BE INSTFtLLE[:,. FI ]OI'.4TINUOI_IS MFIINTENRNCE FIGREEMENT IS REQUIF.:ED. IF FI HFIINTENI::INC:E FIGF.'.EEMENT IS NOT KEPT CUF-:F.:ENT YOU MFI'~' E',E REQUtF.:E[:, TO ENLFIF.:GE ]"NE SOIL. FtBSORF'T I ON S'¢STEM FIND,-.-'FiF.: ¥01_1 I"1F1¥ BE SUB..TEE:T TO F'F.:OSECUT I ON. IF FI F:LFIS$ I .:-,T_,TEfl IS USED THE LENGTH IS; 3'7 la FEEl". IF FI F:LFISS II =T_TE~I IS I_b-,E[ THE LENGTH IS 47. L.--I FEET. 1- [4 ~'3 .:u..=-'-:' .":. ][ lh,,I =-:. F E-- _. 1 :[ C~ ~'-a "_=J. - -" -- BFICKFILLING OF FINM SYSTEM NITHOIJT FII'.,IFIL INSPEE:TI[I",I FIND RPPF.'.OVFIL B"¢ THIS DEF'AF. tTMENT NILL BE SI.JE:..TECT l]-I F'RCSEC..TION.' MINIMUM DISTFINCE BETWEEN FI WELL FIND FIN"r' ON-SITE SENRGE: [.',ISPCISFIL S'¢STEM IS :L~'}~9 FEET FOR R PF:IVFITE NELL OR 2CiA FEET FOR R PUBLIC NELL.. NELL LOGS RRE REQUIRED FIND MUST BE RETURNED TO OF THE NELL COMPLETION. SPECIFICFITIONS FIND CONSTRUCTION DIFIGRFIMS RRE R',,,'FIILFIBLE TO INSURE PROPER I NSTFILLFIT I ON. F' E F-." I'1 I, T "..." Ft L .~ [:. F C_e F: C~ i"-.~ E] ".~-" E F-t F~: F F.: C~ IY,,'H L[ ::C. _"5 Lit E~Z I CERTIF"r' THRT i: I RM FFIMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS FI"-:; Z',ET FORTH B"r' THE MUNICIPRLIT¥ OF FINCHORFIGE. 2: I WILL INSTFILL THE S"r'STEM IN 8CCOR[-"FINCE WITH THE CODES. 3: I UNDERSTFIND THFIT THE ON-SITE SEWER S'¢STEM MR"r' REQUIRE ENLFIRGEMEI"4]" IF ]"HE RESIDENCE IS REMODELED TO INCLUDE MORE THFIN 3': BEDROOMS. S i G N E [:,: ~~_ _~__<~_ _-~_~_ =~'¢_~_.~_ _ _ RPPL I CFINT BILL FOREMRN B .............. : ....................... CO. GEe'tECHNICAL 8 DEVELOPMENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2.280 Soils ~- Foundations Land Development Performed for: Name: Depth (feet) Semi Character~sttc~ 16 ' Ground Water Encountered: Yes Proposed Installation: Seepage PIK Comments: \ ,~ ~~ No v/ If yes, what depth.__~ Drain Field__.__~ Performed by: ~~'~ C%J~-~--~ Date: -'l 82 .... '"1..i'" =,TREE ~., RNE:HEIRRIZjE, IRK. ~:3~:1:~. : '; 27~ -'-'.'~i'1 FERHtT NO. ,:: ,"'7:]..62 ) t~F'F'L. IC:RNT LEE :SLII...t...:[',,,'RN F' O BO::.4 L:: R T :[ D N [:~[:'~ I',iZNiHt...IP'I DIE;TRI'-4CE BE~TNEEN R ~,JEt...L. FIND RN~ CIN-E;tTE LE, E, FEET FOR R F'R]:,.,F*TE NEL. L OR 2E, C, FE:ET FOR O¢-TH~"¢IELL. C:OHF'LETZON. '.E;F'EC: Z F [ CRT [ ONE; RNE:, CONSTRUCT Z [3N D Z RGRRfq:5 IZ~RE R',,,'IR Z (JRBL¢E TO Z N~5~IRE I::'ROF'ER F'ORTH B'.r' THE f,ilJNZC[F'F4LZT'~ OF RNCHORFIGE. ~ , 2: Z N ILL [~2;TRI._L. THIE S'¢STEPt ZN RCCORDFtNCE 1.4~TH THE COE:,~ FtPF'L ]: C:RNT L. EE [ ,,, RN 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~'~ ..'~ -L~L/ HAA# 1. GENERAL INFORMATION Complete legal description Lot I0; Block 7; Preuss Subdivision #4; Location (site address or directions) 10114 Ror~Zd PZ~c¢ Property owner DJ~,~ & w~/?¢ Wd,~h¢.~ Day phone Mailing address 14 Worchc.~t~ Averse, Honolu. Zu, Ha~a,&L 96818 Lending agency Mailing address Day phone Agent B¢~ha~a C~J~¢nd¢.n JACK WHITE COMPANY Day phone Address !09~.~ E~_g6¢ ~,'_,.,~ ~o~ E_-.g6~_ REve% Ak. 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well NOTE: 694-5500 Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written 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 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 fur[her 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 __ Address !7,,3~4 Ea,':ie River Loop Road Eagle River, Alaska 9957~ Enginee(s signature DHHS SIGNATURE ~ Approved for .~Z Disapproved, Conditional approval for bedrooms. bedrooms, with the following stipulations: /203-rev 10/90 ¢.~cc~,~.cca. E wiring at ~his time. rc.~0v~.c~ scv~ra~ y~ars AG Tk~r~ was Ao cvidenc~ of th~ 3¢~ A~ration U~i~ or , It is tk~ ~'nit & wirin~ was By: 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 satis~ certain federal and s~ate requirements. Employees of DHHS do no~ conduc~ 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. · ~ Municipality of Anchorage ~' Department of Health & Human Services :' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~¢,T' ~.~ ~/--'~ ~'¢..¢,o~.% ~1c>'~"~¢ Parcel I.D. A. WELL DATA Well type ~;~'(~ Log present ~/N) Total depth "~ '~ "~ ' Sanitary seal(~N) Date of'test Static water level Well flow Pump level" IfA, B, or C, attach ADECletter. Date completed ADEC water system number ~- Z-I ~7'/ Driller A~'I Cased to ,~r c~ Casing height FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform ~) ~* ~/t>~ ra~ Date of sample: Nitrate Wires properly protected (~/N) V g.p.m. Z AT INSPECTION 1..o. g.p.m. <~ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Lo., o_'N) ~-/~. Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed :~"- /$- 77 Cleanouts ~)N) y High water alarm (Y~ Date of pumping f/.~ ' ~" - '~ / Tank size / Oz~o Compartments Foundation cleanout ~)/N) y Depression (Y/:~ Alarm tested (-Y-/~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~O~ '~' On adjacent lots To property line I O ~' Absorption field Surface water/drainage I C) c~ Foundation Water main/service line (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical co~"~ VCell on lot I E FROM LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access (Y/N) J "Pump on" level at .~/' Pump off" level at ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed _ Length .~--c] ~ Width Total absorption area Depression over field (Y/~j) Results~l~fail) Peroxide treatment (past 12 months) Soil rating ~-'7:~' ¢'/~g- Gravel thickness ¢ Cleanouts present<~/N) System type Date of adeqgacy test for Total depth If ye~, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ O~ ~ To building foundation On adjacent lots ~:>O ~ ''~ Surface water Curtain drain On adjacent lots ~,oc> ~" Property line ~""O' To existing or abandoned system on lot Cutbank ~/~- 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 Signature Engineer's Name -~,M~ HAA Fee $ '~' Date of Payment !~ Receipt Number ~k~l ¢ Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ) 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MA~L~NG ADDR~S~ PRDPE~T¥ RESiDEnT I~ ~iffera~t ~rom a~vel P~ONE 2. BUYER PHONE MAILING ADDRESS 6. TYPE OF'RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other ~..~'SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~ SINGLE FAMILY [~ ONE [] THREE [] FIVE E~ OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE iNSTALLED E] PUBLIC UTI LITY ~'~ "~ '~ Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line 1 WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [] APPROVED FOR ~_. BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED DATE BY ~ 72-010 (Rev. 6/79) July 21, 1982 W~yne Washer Subject: Lot 10 Block 7 Preuss ~ ~aclllt .... cannot Approval for the individual sewer and water be granted until the following '~- have been ~he top of the well casing sea!e~ with a sanitary seal so that it is water tight. ° Exposed electrical wires to the well head are in violation of the Municipality of Anchorage cor~es and must be encase(] in conduit. ~e water analysis r~port needs to be submitted to this office from the Chem Lab, ~6~3 B .~,tr.~et, for our review. A four (4) inch cast iron cleanout needs to be installed to the septic tank and/or leaching area. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to k~ationa! Standards. A listing of private firms performing the test is enclosed. %~nis report needs to be f~ubmitted to t~b. is office for our review. A maintenance co~ntract for the Jet unit serving the sewer system needs to ce obtained from Consteel Company, 376-591%), and a copy submitted to this office for our review and our files. Wayne ~,..Ta sh er July 21, 1982 Page .~ -, Please no'tify this 9el~artment for a reinspec%ion when the Dee~% corrected rf there are any nohec~ discrepancies have ' '~ ~ ~ e' se %'his office at further quest_ohs, D].~a,. call Enclosure ~1: Time Da Insp t.,,/,.,,~N.t..N I ~ PROTECTION 825 S Street, Anchorase. Alaska 9 264-4720 Date ]Received: November 29,1977 '~ 2: Time 11-29-77 Date Da he Pratt Insp Insp P, EQUEST FOR APPROVAL OF INDIVIDUAL SEWER A. ND ,,JA~LR e~..,. ,o Spokane Mortgage Company LendJ_ng institution ..,.~eueot: Mailing Address: 3201 C Street Suite 250 99503phone: Property Owner: Bill Foreman Mailing Address: Star Route Box 5510 .... 694-9056 3. Legal Description: Lot 10 Block 7 Preuss Subdivision 4~ Single Family Residence: (z Multiple Family Residence: Well System: Permit # Con struc'hion Number of Bedrooms: Four Number of Bedrooms: individual well (x) Con, unity/Public System ( ) Depth of Well Well Log on ~±~; ( ) Bacterial Analysis i erml ~ # Septic Tank Size Absorption Area Sewage Disposal System: On-site System ( ~ ~ d Instal.~e 1977 j~ Manufacturer Soils Rate Public Utility ( ) Installer Distances: Well to Septic Tank _ [~' ..... to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest. Lot Line Material Ps, ge %'we Department of Nealth and Environmenka]_ Pro!~eckion Reguest for Appreval ef Individual Sewer and Water Facilities Legal Description: Lot 10 Block 7 Preuss Subdivisio- Commen~z s: Affadavit Attached=l~_ Disapproved: Letter Attached: ( ) Date: Date: Department Worksheet k.,l MUNICIPALITY OF ANCHORAG,.j'": ~,,', ' Department of Health and Environmenta~ P~0~ection ' ' 825 L Street, Anchorage, Alask~ih 99501': "~" '"'~quest for Approval of Zndividual Sewer and W~ter F'~cilities Mailing Address: Phone: Name of Buyer Phone: o Lending Institution Mailing Address: Phone: 4. Realtor/Agent: ...... Mailing Address: Phone: Legal Description: -eSt [~ ~')' ~'" --i cQ-3 : ~""~ ...... '/ " khC(.[13 ~' '" ' Single Family Residence: ~'/ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 8 o Water Supply: *Individual Well (~-~ Public/Conm~unity System If Individual Well, well depth Q~)~O~.~O If Community System, name of system Sewage Disposal System: *~n-site System If On-site System, date of installation: (L0/.. Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77