HomeMy WebLinkAboutINDIAN VALLEY ALASKA BLK 1 LT 2pA*c.eL'ORO-Olfr - ova
y
~ MLINICIPALITY OF ANCHORAGE "~
i~ 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
PHONE ~./~ I~NEW
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
' NO. OF BEDROOMS
Material No. of compartmeo~s
~ ~ M~nufacture~
~ ~ Liq, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth
Well Dwelling PERMIT NO.
~,~ DISTANCE TO:
O ~ ~ Manufacturer Material Liquid capacity in gallons
P E R M~,T NO.
~ Well Foundation ~earest I~l~e ~
~ DISTANCE TO: I~O ~0r I ~
No. of li~es Length of e /
~ Top of tile to finish ~rade~ ~, Material Beneath tile
Length Width Depth
¢ Total offective absorption area
~ ~ T~pe of crib Crib diameter Crib depth
m Well Building foundation Nearest lot line
~ DISTANCE TO:
Class Depth Driller Distance to lot line ' PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER ~-'
PIPE MATERIALS
SOIL TEST RATING -- '
INSTAEEER
DATE LEGAL
72-013 (Rev. 3/78)
DEPAR'I-MEN'I- OF HEALTH AND ENVIRONMENTAL PRO'T'ECTION
825 L STREET, ANCHGRAGE, AK 9950]
264'-4'?20
PERM I T NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
MAX BEDROOMS:
850394
07/08/85
GEORGE REANDEAU
8550 EAST 1] (iT.
ANCHORAGE, AK 99504
3~7-3442
SUBDIVISION: INDIAN VALLEY ALASKA LOT: 2
SECTION: 5 TOWNSHIP: 10N RANGE: 1W
41600 (SQ. FT. OR ACRES)
5
BLOCK:I
Listed below are the options ava~.lable to you in designzng your s~.ptzc
system. Choose the option that best £its your site.
IF F~ D~Z N C ~-~ ~£D
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0
GRAVEL. DEPTH (FT.) 4~0 0.5
TOTAL DEPTH (FT.) 8.0 4.5
GRAVEL WIDTH (FT,) 2.5 17.0
GRAVEL LENGTH (FT.) 4~5.0 34.0
GRAVEl._ VOLUME (CU.YDS.) 18.8 21.5
TANK SIZE (GALS) '~1,0,00.0 .~ 1.~000.0 ~.~.
SOIL RA'¥INS (SQ. FT./BR) 120 125
** TANK MUST HAVE AT LEAST TWO ~OMPARTMENTS
4.0
3.5~
7.5
5.0
4 1 ,, ()
30.4
000.0 .~.
1~5
I certi£y that:
1. I am familiar with the requirements ~or on-site sewers and wells as set '
Forth by the Municipality o£ Anchorage (MOA) and the State o~ Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria, oF this permit.
3. I' will adhere, to all MOA and State oF Alaska vequi~em~ents For the set back
distances ~rom any existing well, wastewate~ disposal system or Public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this pea, mit is valid ~or a maximum o~ 3 bedrooms· ~nd
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WIL. L. NOT BE APPROVED W'ITHOLJT AN ELECTRI~SAL INSPECTION REPORT; AND (3) THE
·
APPL I CAN]" ~ ~EORGE REANDEALJ
IssoED BY .~ ~ DATE:
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
17f
18j
19.-
20-
COMMENTS
SOILS
LOG
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L, Street, Anchorage, Alaska 99501 264-4720 ~-~ £J/~, ~ ~
SOILS LOG-- PERCOLATION TEST '~ %~"
SLOPE SiTE PLAN
WAS GROU.D WATER
E.CO J.TERED?
0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE I~,,,~.J.J~ VJSI~41~ ~. ~
TEST RUN BETWEEN ~--/~=--. FT AND -- FT
PERFORMED BY:
72-008 (6/79)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol ~ Geophysicol Surveys
Drilling Permit No.
LOCATION OF WELL (Pleo~e complele either ID, lb or lc.) A.D.L. No,
~-o.ljBorough Subdivision Lot Block 'b~]l '/4qlr$. Section No. Tov~nahlPN~] Range E[~ Meridian
~DISTANCE AND DIRECTION FROM ROAD INTERSECTIONs
OWNER
OF
WELL:
WELL LOG Feet Below 4. WELL DEPTH: (flnel} 5. DATE OF COMPLETION
Meleriol Type Top Bottom
g~o~g~r~ ~b/~. ~av~/~A~ ~ · 9+ 6. 0Cable ldo' ORotary OOriven ODug
51L7~/ ~AL/bY ~A~JEL ~T q~ ) J ~ ' 7. USE; ~omeltlc ~ Public Supply ~ I~dultty
~ 8. CASING: 0 Threaded ~ Welded
I~.GROUTING Well Grouted: ~ Yes ~ No
Material: ~ Neat Cement ~ Other:
) ' 15. PUMP; (if available) HP
/ Length of Orop Pipe ft. capacity g.p.m.
~ Subm. ~ der ~ Centrific~l ~ Other
14. REMARKS:
WATER WELL CONTRACTOR'S CERTIFICATION:
15. W~lar Temperot,re o ~ F ~ C
This well was drilled under my )urlsdlctlon and this report is lrue lo the best of my know~edge and belief;
iF'ERMIT NO:
DATE ISSUED:
h~'~L~l'~ ~ C~ ][ F'AE_ I T'Y OF~ ANE;HOF(AGE
DEPARTMENT [~'~' HEALTN AND ENVIRONMENTAL · ]TECTION
825 ~-~STREET~ ANCHORAGE, AK 99~0/1
ON--~B I -[E
850316
06 / 18/85
APPLICANT:
ADDRESS:
CONTACT PHONE:
GEORGE REANDEAU
8550 EAST 1~ COURT
ANCHORAGE~ AK 99504
557-344~
LEGAL DESCRIP:
LOT SIZE:
SUBDIVISION: INDIAN VALLEY ,~il:;~. LOT: 2
SECTION: 51/2 TOWNSHIP: i1N RANGE: 1W
41600 (SQ. FT. OR ACRES)
BLOCK: I
I certi£y that:
1. I am familiar with the requirements for on-site sewers and wells as set
£orth by the Municipality of Anchorage (MOA) and the State o£ Alaska.
~. I will install the system in accordance with all MOA codes anU regulations,
and in compliance with the design criteria o£ this permit.
3. I will adhere to all MOA and State of Alaska requirements ~or the set back
distances ~rom any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
1SSUED BY .~~ ......... DATE: _~./~.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date / ~ -- /~ ~;-~
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
NameS~¢~¢~¢¢~¢¢, ~ Telephone: Hom~-~¢ ~? Business~
(b)
Applicant
(c) Applicant is (check one): Lending Institution ~; Owner/builder~Buyer ~; Other ~ (explain);
(d) Lending Institution _?./-J,¢-~'¢¢ ~' '~
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAAto the following address:
TYPE OF RESIDENCE
Si ngle-Family [~}¢~ulti-Family []
Number of Bedrooms ~'~---
Other
WATER SUPPLY
Individual Well J~Community [] Public []
Note: If community well system, must have written Confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [~t~PPublic [] 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 (11/84)
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.
Address
Date
Engineer's Seal
DHEP APPROVAL x '~ , '~
Approved for "7~/-~-pE'-~) ~ bedrooms by ¢~,~d~ Date
Approved Disapprove~' Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
72-025 ( 11/84)
MUNICIPALITY OF ANCHORAGE (MOOr
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description: [.oT
WELL DATA
Well Classification '~ ~--"~
Well Log Present (Y/N)
Total Depth J ! ~-. Cased to
Static Water Level _~
Casing Height 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 Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
P, CEIVE
If A, B, C. D.E.C. Approved (Y/N)
DateCompleted ;~ON~.2.~ J~'~;-~ Yield
J I ~-- Depth of Grouting N Ol~
kto~
Pump Set At 1~ OT'J'O
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
J ~"~O ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
; Date
B. sEpTIC/HOLDING TANK DATA
Date Installed ~//~.~ Size 1~ No. of Compartments
Standpipes (Y/N) ~' Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ~ Date Last Pumped N/,~
Pumping/Maintenance Contract on File (Y/N) [~'/,~O~. ; for
Holding Tank High-Water Alarm (Y/N) [~',/',~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation J~
To Disposal Field ! ~
To Stream. Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area "~"~
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field /1/
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ~ ~" D
To Existing or Abandoned System on
; On Adjoining Lots ~ ~ ~
To Cutbank (if present) f'~O ~ ~
NoH~,
D. LIFT STATION ~ 0 ~'~, ~
Date installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified..,or conformed to all. llMOA and HAA guidelines in effect on the date of this inspection.
Signed T.~ Date
Company ~'~~ MOA No. ~'..~ ,.~ ~"'- C3 ~/'
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
.~., APPL'~NT FILLS OUT UPPER H~'~ ONLY
j RoaityCo,&A~nt ~ ~d"'~ f~,k~r/ Phone
Code
~81n~le Family No of"
' ~ Multiple Family . Bedroo~ ~ ~
-Other
Water SuPply A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
~dnd v d~l
:;' ~ C~m~unlty" For wells drilled prior to that date, give well depth (attach log if available).
;.- D Pubflc Utility
'-.D P~.~II ly . When Connected to Public Utility:
. ~ ' ' NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
E,U .~.. ALITY OF ANCHORAGE ,
DEPARTMENT OF HEALTH & ENVIRONMENTAL PRoTEcTION
Environmental Sanitation Division
825 L Street o Anch~age, Alaska 99501 · Telephone 264-4720
CERTIFICATE OF INSPECTION
ON.SITE SEWER AND WATER FACILITY
: :Malllhg'Ad~e~,
ion
Howard G. VanOrman
PoO.Box I'0-2037 Anchorage, AK , 99511
Lot 2, Block 1, Indian Valley Subdivision
Type o! Dwelling
X~ Single Family
C. Muttlple Family
'.~_ Other
'CONDITIONSOFAPPROVAL
':~hat::a 500 gallon septic tank
eXisting on the property; this is
~'adeq~ate"-for a One(l) bedroom
.~dwelling'.only.
4. Sewage Disposal
X~ Individual [] Public Utility .
[] Holding Tank
5. Water Supply
X~ Individual
[] PuUIc j
[] Community~ (shared) J
APPROVAL FOR
one BEDROOMS
· [~ CONDITIONAL
[] DISAPPROVAL THIS APPROVAL NOT VALID
~M~APPROVED WITHOUT DEPARTMENT SEAL
APPLI .~NT FILLS OUT uPPER HA!. ONLY
~tbP~e~ty'Owner, ///~ [.L.)~'~ .~..~:[ ~ ~ ~ ~ ~ ~ -'~-'/ Phone
Ma~n~ Addre~ ~ Zip Code
Address Zip Code
Lendinglnstitution (,',..~7 ~ ~ ~,'~,~ A 2~ /Z~,~ K ~X)e l.~vy~ &~xT& Phone
Address Zip Code
Phone
Realty Co. & A~nt ~
Type of Resi~nce
~gle Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~lndividual
~ Community ~' ~ ..... For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
S.wer ~,o~, ,.U~v~u~, ~n~,eU:
When Connected to Public Utility:
~ Public Utility
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
.
Time : Time Time Time [ ~ '~ 0
Date Date Date Date
Inspector Inspector Inspector Inspector
~ ? ~ ENVIRONMENTAL PROTECTION
J U L 1.. g 1983
RECEIVED
( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( )DISAPPROVED That a 500 gallon septic tank existing on the
property; this is adequate for a One(l) bedroom
( ) CONdITION. AL APPROVAL*
?/~k/;T~ ~ dwelling only.
OAT , .-- ,
Soils Rating Date Sewer Installed Well To Absorption Area /.~ /.iF Well Log Received
p ~../ ~ / t' Well to Tank Septic Ta~k Size
72-023 (3182)
ALASKA e/- rdlROFImeFITAL CONTROL SeR UiCe$, IFIC.
~r~clineerin§ 6 ~nmr'onmcnlal Studies
HOWARD VAN ORMAN
P.O. BOX 10-2037
ANCHORAGE AK 99511
JULY 25 1983
SELLER - HOWARD VANORMAN
SUBDIVISION-INDIAN VALLEY
BUYER-RICHARD REDMAND
BLOCK-2 LOT-1
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 225 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 55 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
1 BEDROOM HOME.
THE SEPTIC TANK WAS PUMPED ON 7/25/83 .
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 500 GALLONS IS INADEQUATE BY
500 GALLONS FOR THIS HOUSE OF 1 BEDROOMS.
1200 J~'st 33rd Au6nu¢, $,Jt¢ J~ · Ancbra§6, AJasb 99503 · (907) 276-1351
J~ly 22, 1983
lloward ~. VanOrraan
p. Oo Box 10-2037
~w 99511
Anchorage ~
Subject: Lot 2~ ~lock 1~ Indian Valley Sub, iris!on
Approval for the individual sewer and water facilities cannot
'. been co~.~p!e~ed '
be gr~nted until ~he ~ol!owi~g items ~ave
o e 0
· ~ ~n the rece].pt and v~l~-~=~ .~ ~ ,=~-~ ~ to verify the
/~ the gctna~ ~.~a~..-. ~ '-
ExpoSe the septic tank manhole to verify its
and/or
leaching area for our inspection- This is to insure
.~inim~',~ distanc~ requirenents are met between the well and
~ be "erfor~e,~ on the existxn..~
~n a..,~q~-~ ' · ,~ ~ q~h~rmi't~e if the sys~,~
~ ]eac ~ing area, ~his t, , ~ .~ ,,,~r~s, A listing
/,~ adefinate ~ccord%/%~ to . -. · ..... ~ ..... 1 , '~hl8 report
~ ~ ........ ~ ..... f,~'~ a relnspection when the
Pie~se notify this ueparn.a=-~ -~ ,~-~ If thera are a~v
' ~ r .. · ~ been corre~u~,-~- ' ,
note~ disarepancie~ ~ale ~--, ~-~ ~e at 264-4720.
Sinc(*,rely,
Jim ~%ober t s
Assistamt Environ?aental Specialist
j~. 3/e J/i;nv