HomeMy WebLinkAboutIVERSON LT 1v rson S/D
NAME
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
MAILING ADDRESS
LEGAL DESCRIPTION
lOCATION
DISTANCE TO:
Liq. ty in gallons
Absorption area
inside length
IF HOMEMADE:
No. of compar.~ernts
Liquid depth
Well Dwelling PERMIT NO,
DISTANCE TO:
urer Liquid capacity in gallons
Mat~
idth
Material
INearest lot line.~
Trench width
..~ ~_r~ inches
Foundation
Total len§th of lines
Material beneath tile
DISTANCE TO: Well /~.~)/,2 I
/ Length of each line~,.~
Top of tile to finish grade~ )
PERMIT N O,. O~.1,/~..,//~.~
Distance between line~//~
Total effective absorption area
PERMIT NO. ~ ~ 4.¢,
Length
~e of crib
DISTANCE TO:
Class ~ ~_~/
DISTANCE TO:
Width
:rib diameter
Depth
Crib depth
Building foundation
Total effective absorption area
Nearest lot line
Depth Driller Distance to lot line PERMIT NO,
Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
APPROVEp / /
DATE
LEGAL
PERMIT NO.
RPPLiCRNT
LOCATION
LEGAL
ERICKSON"S BA(}'KI.4OE
CHUG IRK
[EFHE'FME~..T,_,.:,~ I HEFILTH FIND EN',,,'IR'NMEMTRL_ _
c .... "'b ,"STREET., FIH]FIOF'RGE, FIK.
T±SN RiW SEC 9 LOT i]:0
LOT SIZE 60000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MRNtMLIM NUMBER OF BEDROOMS
SOIL RRTING (SQ FT?BR)= ±]:0
THE REQUIRED SIZE OF' THE SOIL ABSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH ,.'.'IN FEET.'." OF THE TRENCH OR DRA!NFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROLIND AND THE.BOTTOM OF THE E:,.-','CA',,,'RTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRFI',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OLtTFRLL PIPE
RN[." THE BOTTOM OF THE E~WCAYATION (IN FEET).
PERMIT RPF'LICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLATION INSPECTIONS OF RN'¢ WELLS RDJRCENT TO THIS PROPERTY AND THE
NUMBER OF' RESIDENCES THAT THE ~4ELL WILL SER'¢E.
BRCKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION AND APPRO',,,'RL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AN[:, RN"r' ON-SITE SEWAGE DISPOSAL. S'T'STEM IS
±00 FEET FOR R PRI'¢ATE WELL OR 'tSR TO 2A0 FEET FROM A PUBLIC WELL DEPENDING
LIPON THE TgPE OF PUBLIC WELL.
MINIMUM DISTFINCE FROM A PRIVATE WELL TO R PRI',,,'RTE SEWER LINE IS 25 FEET RND
TO A COMMUNIT',? SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MFW APPLY. SPECIFICATIONS AND CONSTRUCTION D!AGRRMS RRE
R',,,'RILFIBLE TO INSURE PROPER INSTALLRTION.
I CERTIFY THRT
i: I AM FAMILIAR WITH 'THE REQUIREMENTS FOR ON-SITE :-_-;EWER'=; AND 14ELLS AS SET
FORTH B"r' THE MUNICIF'RLITY OF RNCHORFIGE.-
2: I WILL INSTAL[.. TFIE '=;"?STEM IN ACCORDANCE WITH THE CODES.
2:: I UNDERSTAND THRT THE ON-SITE SEFIER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2: BEDROOMS.
SIGNED: ....................................................
APPLICRNT ERICKSON¢S BACKHOE
I_-,.:, _lEI,-'""1 ' Bi-" ' ................................... D M FE_L~.._O..._.,QJ ,~' - ...........
V4. 0
Location:
], ~JNICIPALITY OF ANCHORAGE~ ~
Department ~ Health and EnvironmentaI~rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
.. ,~_. ~
~)~ ?t ~ Mailing Address :~]/~
Phone Number: ~<~
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~. Soil Rating(sq.ft/br) / ~ ~3
The Required Size of the Soil Absorption System Is:
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 outfall pipe and
the bottom of the excavation(in feet). /~ GALLONS * *
· * REQUIRED SEPTIC(HOLDING) TANK SIZE =
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.
· * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final 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 a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion°
Other'requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
· * * PERMIT EXPIRES DECEMBER 1 9 8 1 * * *
I certify that: .
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
t~ ~sidens~is remodeled to include more that 3 bedrooms.
SWP/024(1/81)
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE SITE PLAN
1
2
~3
~ 7
8
9;
11
12
/4/,4- r,~P
?
WAS GROUND WATER
ENCOUNTERED?
13-
14-
16-
17
18
19-
Robert A, Sh
No, 145~
20-
SOILS LOG
[] PERCOLATION
TEST
IF YES, AT WHAT // / E
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN
FT AND -- FT
PERFORMED BY:
~S~& S Engineerln~
72-008 (6/79)
DATE:
SUBJECT: Water well easement from Lot 130B to Lot 130A, S\'t~ ~
Section 9, T15N, RlW, SM, AK. (Iverson Subdivision)
This document describes a water easement from a public deep
well located on Lot 130B and running west northwest to the res-
idential dwelling located on Lot 130A. The easement width is sev-
en and one half feet on each side of a direct line from the well
on Lot 130B to the southeast corner of the dwelling on ~.ot 13On.
The subject- ~ ~
ea~emen~ shall run with the land and continue so long
as there is no potable water source on Lot 130Ao The owner/s of
Lot 13_OB__shall provide water.~o_.Lo~t~.~.~30A on demand, at a monthly
r~te not to exceed ten (10)~d011ars. ~he drawing below~ depicts-~the
easement pictorially. This document was drawn by Albert L.' and
Lauralea Iverson, husband 'and wife, and present owners of the ['
Iverson subdivision, and their signatures are afixed below° The
subject of this document shall continue and apply to any future
owner/s of the above described property.
State of Alaska, Third
District:
LOT 130A- ..... ~c~:-.,;~6~ '- This is to certi£.v ~that on:
yoz, oe~ore me, t~e unde~-/~
si~ned Notary Public in aRd
2or the State off Ala~;ka~
personally appeard Albert L.
? ~ . and Luaralea Ivprson, known
: ~ In wztness whereof, I have set
' - ~ my han,d and seal ~he day and
/ ar irst er '
aT '
:?' ,';' .... ~'.:'.'9 ', ~
: ..: (.~ / , .) : ,
L.~, STATE OF ALASKA x_~'
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
Jot
PUBLIC WATER SYSTEMS
APPROVAL TO CONSTRUCT
Plans for the construction or modification of ~/-~o~7 /5 0 A
/&d--d ~ public water system located
Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
i~___approved'
[] conditionally approved (see attached conditions).
BY TITLE DATE ·
If construction has not started within two years of the approval date, this certificate is void and new. plans and
specifications must be submitted for review and approval before construction.
B. APPROVED CHANGE ORDERS
Change (contract order no. or descriptive reference) Approved by
Date
APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
is made available to the public.
The construdtion of the L-,JT~ J ~ /7 'J"- I ~'~/~ ~J uJ
water system was completed on ~'.) ! '7 "~ ~
granted interim approval to operate for 90 days following the completion date.
publ,c
(date). The system is hereby
BY TITLE DATE
As-built Plans submitted during the interim approval period, or an inspection by the Department, has confirmed
the system was constructed according to the approved plans. The system is hereby granted final approval to
0 p. rat e. ,/~,~.%/~_/~ ~,
- .... o ¥
BY TITLE DATE
18-0407 (Rev. 11183)
DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C)
3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C)
4. GOLDENROD - MUNI-BOROUGH (Complete Section A}
. - 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 ~,~/8'-.~
GENERAL INFORMATION
(a) Legal Desc~ption (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name _//~:~/~2¢¢¢ra- ~ -- TeTphone: Home .~~c. Business
one): Lending Institution []; Owner/builder []; Buyer []; Other/E3, (explain);
(c)
Applicant
is
(c_.heck
(d) Lending Institution · //~'-'~,-¢-/--~¢-¢ .~-~A.~ _~¢.~¢~-i-elophone
Address
Estate Company and Agent~L~ ~/~'~ ('~~'
(e)AddressReal ~--~'~:/ (~'¢~-/, ~
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family J~ Multi-Family []
Number of Bedrooms k.:¢
Other
WATER SUPPLY
Individual Well [] Community'~ P~
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 ¢1/84)
~"~'~ :--' --mING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION,
As certified b m seal aff xed hereto and as of the validation date shown be ow verify that my investigation of th s 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 , o ~',~¢~"~4~ Telephone .~//f'~. . /~, ~
' / /
Address --, *~,,,.,~ ~¢ ¢,~ ....... /
Date
Approved for (./~¢~ms by -,~,. //~f~
Approved ~ Disapprovec(/ Conditional
Terms of Conditional Approval
Date
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
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAAi
CHECKLIST - FEBRUARY 1984
W]~,r .L [i~TA
Well classification ~
Well Log" P=esent ~Y.~
Total DePth ' /-~/~ ~' Cased to
Static Water Level /0 ~ Pump' Set At
Casing Height Above Grcund / ~
ElectriCal Wiring in Conduit Y~)
Separation Distances f~cm Well:
To Septic/H~ Tank on Lot /j-Lo ¢~
To Nearest Edge of Absorption Field on Lot/~D %
To Nearest Public Sewer Line /~J ///4
Legal Description:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENt[AL PROTECTIO?I
I985'
zJ .f0EIVED
If A, B, O~ C, D.E.C. Approved~/~U
Dat$ Completed /~7~~' Yield S//~/~v
9/0 /- Depth of G~outing ..
Sanitary Seal on Casing &Y~N)
Depression Around Wellhead (Y~_~
; On Adjoining 'Lots /~'-cQ
; 0~. Adjoining Lots /~--O
To Nearest Public Sewer
Cleancut/Manhole ~ ~ ~ To Nearest Sewe= Service Line on Lot
Water Sample Collected By~ ~r~ ~¢¢/~,/~;~ Date .
Water Sample Test l~esults _~-z-/j-~¢ ~-~ ~-~/
/
C~-nts '~ ~ ~ ~
B. SEPTIC~ TANK DATA
Date Installed dc¢ (~ ~ ~ / Size / OPm No. of Ccmpartments ~
Standpipes ~) Ai=-tight ~ps ~) Foundation Cleanout (Y~
~ession o~= Ta~ (Y~ rote ~st ~ - / ? - ¢~.
P~ing~intenan~ ~n~a~ ~ File (Y~) ; for ~
Holding Ta~ High-Wate~ ~a~ (Y~) P~ ~=a~f Holdi~ Tank ~t (Y~) ~
Separation Distances f~cm Septic/F_~ Tap~k:
To Water-Supply Well /~19 ~-
To P~operty Line /O ~
To ~ter ~i~vi~ Lir~ O~m /~
Co~ ~
To Building Foundatic~_ /69
To Disposal Field ~'
To Stream, Pond, Lake, o~ Major D~ainage
CoKments
Receipt ~
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD [XATA
Soils Rating in AbsorPtion Strata
Date .Installed
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y~
Results of Last Adequacy Test
/'.~D ~//~. Type of System Design'S./4
Length of Field
Depth of Field
Gravel Bed Thickness
~ Standpipes P~esent
Date of Last Adequacy Test
Separation Distance f~cm Absorption Field:
To Watez,-Supply Well /~
To Building Foun~tion
Lot ~ ;
To Wate~ Main/~vi~ Line
To St~e~ond~ke/~ ~jo~ ~aina~ C~se ,
TO ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea
Conmgnts
D. LIFT STATION
Date Installed
Size in Gallons
"PLu~ C~" r~.vel at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Din~nsions
~nhole/Access (y/N____J)
Off" Level at
Vent (Y/N)
~n~cles during Adequacy Test.
M~ets MOA
Comments
** Check Permitted Bedroc~ Rating Against HAA Request **
I certify that I have checked, verified, ~ confoc,~ed to all MOA
on the date of this inspection.
KB1/d5/s
Date ~/~S~
[Page 2 of 2]
HAA~C~.es in effect
2-15-84
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
Date Sewer Installed -"~""'"'""'=="~-- =Pl~l'nit No. Septic Tank Size
/6 -- ~/ Holding Tank Size
Soils Rating Well To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner ~/~O L~~ ~/~/~ Phone
Lending Institution
Realty CO. & Agent ~(/ ~t~ - ~', ~J ¢~C Phone
Legal Description ~
s,re.t.oo t,o. LOT
Typ~f Residence
~Single Family
~'Multiple Family No. of Bedrooms
D Other
Water Supply
D Individual A~ACH WELL LOG. A well log is required for all wells drilled since June
Community 1975. For wells drilled prior to that date, give well depth (attach log if
Public Utility available.)
Sewage Disposal
~ Individual Year Individual Installed:
D Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
January 14~ !.982
A,L. Iverson
3!00 Sheldon Jackson
Anchorage, AK 99504
Subject~ T15N, RtW, Section 9, Lot 130A,
Dear Mr, Iverson:
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
° The top of the well casing sealed 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 codes and must be encased
in conduit.
° The water analysis report needs to be submitted to this
office from the Chem Lab, 5633 B Street, for our review.
° The sewer system servin~ the dwelling directly to the east
of you will need to be iocated so that we may determine %he
distance between the sewer and community well.
Please notify this department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincere!y~
Robert C. Pratt
Associate Environmental Specialist
._ CHEMICAi.& 'G~_~,OGICAL-LABORATORIES ~.. ALASKA, INC.
~' ~ TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER
/~_~ ' · 274-3364 5633 B Street
/..."J-~,;,.;--.~Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
WATER SYSTE M:
Water System Name
Phone No.
Mailing Address
State
City
Mo. Day Year
Zfp Code
· SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no.
[] Special Purpose
[] Treated Water
[] Untreated Water
SAMPLE
NO. LOCATION
I 7'/::~"
2 I /
.¥
I
, I
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
[] Satisfactory
[] Unsatisfactory
--I Sample too long in transit: sample should
not De over 48 hours old at examination
to indicate reliable results. Please send
new sample.
Date Received
Time Received ; · '., ,
Analytical Method:
[] Fermentation Tube
E:YMembrane Filter
Lab Ref. No. Result* Analyst
I ICI
I
I
READ INSTRUCTIONS
BEFORE
COLLECTING SAM PLE
06-1220 {b)
Rev. 1978
BACTERIOLOGICAL WATER ANALYSIS RECORD
Date Collected Source
L-~b. NO.
· resumptlve 1Omi 1Omi ZOml 1Omi lOml Z.Oml 0.1mi
24 Hours
48 Hours
gonflrrnatory
24 Hours
48 Hours
EMB Broth 24 hours: Broth 48 hours:
Multiple Tube Report: Z0ml Tubes Positive/Total AOml Portions
Membrane Filter: Direct Count Collform]],OOml
Verification: LTB BOB
Final Membrane Filter Results - ,, ':; Collform/lO0ml
_ ~', ~ . : ~ ~.':'.
Reported By ·: Date