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Home My WebLink AboutEARL RAY BLK 3 LT 26 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 PHONE [] UPGRADE LEGAL DESCRIPTION Well DISTANCE TO: I Manufacturer 1 Liq' capacity in gall°ns IF HOMEMADE: DISTANCE TO' I Well Manufacturer DISTANCE TO: I NO. of lines I Length of each Top of tile to finish grade / L I Length Width Type of crib Crib diameter Well DISTANCE TO: JClass Depth DISTANCE TO Building foundation JAbsorption area : Dwelling Material Inside length W dth NO. OF BEDROOMS PERMIT NO. No. of compartments Liquid depth Material Nearest lot line Trenc~h Dwelling PERMIT NO. Liquid capacity in gallons Foundation PERMIT NO, Distance between lines Total lengt h~f~ne~s Material beneath tile inches inches Depth Crib depth Building foundation Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Driller Distance to Iqt line Sewer line Septic tank PERMIT NO. Absorpt on area(s) OTHER PiPE MATERIALS SC~ ~E~T R A'T~.~G~ RF~R KS .Dde_J APPROVED . DATE LEGAL 72-013 (Rev. 3/78) DEPARTMENT O~HERLTH AND ENVIRONMENTAL ~OTECTION 825 "L ~TREET., ANCHORAGE., AK. ~9...~,~ - - 264-4~20 PERMIT NO. ( 8~065~ ) APPLICANT R~CHRRD SANE:, P.O. BO;q LOCRT ~ON CH~CKDEE DR~VE LEGAL : TYPE OF SO~L ABSORPTION SY~TEN ~: TRENCH E. R. LOT ~I~E 3:7000 SQLIRRE FEET MR>¢IMUM NLIMBER OF BEDROOM_, :,OIL RRTIN.~ (SQ FT,."BR)= .~"lb THE REQUiEE[:, _,I,:.E OF THE =,OIL AEzORFTIUN , DEPTH=f= dL:--~ I~ E ~'-J,_.~ T H= 4t ,3 R fi'..-' E L [:.EP TH=~=.'-~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. 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 OUTFRLL PIPE AND THE 80TTOM OF THE EXCAVATION (IN FEET). RE _c-!!J I RED. :=~EF'T I C: PERMIT APPLICANT HHz, THE RE=,PON:.IBILITY TO INFORbl THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER 0F RE_, I DEN ..E_, THAT THE WELL WILL _ERIE. BACK. FILLINg3 OF ANY S~;,TEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R 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 B COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERi-1 I T E>~F' I RES [)ECE~'IBER~---":.1... i~_'_~O I CERTIFY THAT t: I RM 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 THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS ~MODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED:~~,.~-.~,=~__~__~ APPLICANT RICHARD SAND RECEIPT~ Date~/~C. ¥ ~9 ~ 6602 Received Fro~ ~~ ~~ ~ ~ ~ ~ Dollars$~,~ ACCOUNT : ~ AID ) ACCOUNT ~ CASH DUE ORDER O & E ENG,~qEERING & DEVELOFMENT CO. Russell Oyster 694-2774 Performed for: Legal Description: Depth (feet) 1__ 2__ 3__ 4__ 5__ 9__ 10__ 11 __ Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Earl Ellis SOIL LOG 688-2280 Name: //~/¢'. ~~_~d~:> ~--,z.,' ,u~ Tel. No. Mailing Address: ~--~', ~ ~' ~ ~ ~ z_~- ~-~. ~_ Soil Characteristics PLOT PLAN 12__ 13__ 14__ 15__ 16___ Ground Water Encountered: Yes Proposed Installation: Seepage Pit No '/ If yes, what depth Drain Field PERC. TEST Comments: Date: /'¢/o~ /1:/'7 '~0 DOC Co, dDa P.O. BOX272 CHUGIAK, ALASKA 99567 a TELEPHONE688-2759 OV;NER OF LAND ADDRESS LE GAL DESCRIPTION DATE - Started PERMIT NUMBER DEPTH OF WELL Ended STATIC LEVEL OF WATER FT. GALS. PER HR KIND OF CASING ~--' KIND OF FORMATION: From ~'; Ft. to ~" .Ft.. From ~:'' Ft. to t- I Ft. From Ft. to_ Ft. ~ ;: 4( Ft. From 'W / Ft. to_ ~ From /~i'' Ft. to i','; Ft. From: d ?'' .Ft. to /?-/ .Ft. From_j ; / Ft. ~o Ft. From Ft. to__ Ft. From_ Ft. t0 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. - . , ~. , ~ w,:-~,. From Ft. to From_ From From From From __ From From From From From. Frmn__ From From Ft. _Ft.t~ Ft._ .Ft. to Ft._ Ft. to___ Ft~ Ft. to Ft Ft. to Ft._ Ft. to Ft._ _Ft, to_ _Ft. Ft. Ft. to_ Ft._ Ft. to.__Ft. _Ft. to__ _Ft Ft. to_ Ft. Ft. to Ft. Ft. to Ft. Ft. to_ Ft. From Ft. to MISCL. INFORMATION: DRILLER'S NAME MUNIC~ I ~8L I'r¥ OF-- F~NCH~R~(3E DEPARTMENT HEALTH AND ENV I RONMENTAL "DTECT I ON 825 ~L' STREET~ 8NCHORAOE., - ' ~64-47~0 WELL PERM I T PERMIT NO. APPLICANT PETER~rCREEK CONST. LOCATION MiLE/~i GLENN HIWY INC PO BOX 50D E.R. LOT SIZE 3?000 SQURRE FEET MINIMUM DISTANCE BETWEEN H WELL 8ND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE I$ 75 FEET, WELL LOGS ARE REQUIRED RND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DHY$ OF THE WELL COMPLETION. OTHER REQUIREMENTS MR~ RPPL~. SPECIFiCHTIONS 8ND CONSTRUCTION DIHGRHMS 8RE RVRILRBLE TO IN~URE PROPER INSTHLLRTION. PERM I Ti EXP I RES DECEMBER ~1:: ~ 1~80 I CERTIFY THRT i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORRGE. 2: I WILL~ THeE S~M IN ACCORDANCE WITH THE CODES. ~PPLICANT PETERS CREEK CONST.~ INC / ~ V4. 0 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of En. vironmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 051-113-28 GENERAL INFORMATION Complete legal description Earl Ray CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 26, Block 3 Location (site address or directions) Property owner Mailing address 2925 Debarr Road, Anchorage, AK Day phone 694-5195 msq 99508 Lending agency Mailing address Agent Ad dress N/A Pat Arnett/All Star Realty 2207 E. Tudor Road, Suite 53, Day phone 561-7827 Day phone Anchorage, AK 99507 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 2 NOTE: TYPE OF WATER SUPPLY: Individual well × 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: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, proWde written confirmation from State ADEC attesting to the legality and s u ~ ?2-025 (Rev, 1/91) Front MOA ~1 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my invest_i_gation and inspection, the on-site water supply and/or wastewater disposal system is ir~ compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone 694-5195 Name of Fi~m'. Eacjle River Eng~neerincj Sezvices Address P.O. Box 773294, Eagle Pd.ver, AK Engineer's signature DHHS SIGNATURE fApProved for Disapproved. Conditional approval for 99577 bedrooms, ~ ' bedrooms, with the following 'stipUlations: Additional Comments By: The Municipaliht of Anchorag0 Department of Health and Human Se~tices (DHHS] issuos Heelth 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 satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The ~unicipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. , ,,. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type ~IY~?~ Log present (WN) Total depth Sanitary seal (WN) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed ///~'~ Driller Cased to /~o / CaSing height Wires properly protected (Y/N). g.p.m. FROM WELL LOG Date of test ///~[.~ Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/hektk~ tank on lot Absorption field on lot -J"/~) ' Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /~,,V'~ WATER SAMPLE RESULTS: Coliform -(~ Nitrate Date of sample: ~ q//r2/c~ ~ L Collected by: Other bacteria B. SEPTIClH~I~I~N~G TANK DATA Date installed /// Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size /~c~O _~.. Compartments Foundation cleanout (Y/N) ~$ Depression (Y/N) Alarm tested (Y/N) ~ 0~/~ Pumper SEPARATION DISTANCES FROM SEPTIC/.I=I~L:4~)tNG TAN? T.O:., Well(s) on lot -7~/0~) / On adjacent lots "-/~/_~_~) Foundation To property line '7~ ~ / Absorption field ~ I WaterJa~a~/service line ~/~ / Surface water/drainage ~"//~ 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length /~ ~ / Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) / ///o~ Soil rating (GPD/Ft2) Width ..~ (~..~ ~/ Gravel thickness 7o~ ~~r.~,~ Cleanout present (Y/N) ~//~/? ~ Results (pass/fail) r_~//~/~ System type ~, ~ Total depth ~ Depression over field (WN) ~ for ~ Bedrooms After test ~.~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~-}DO To building foundation On adjacent lots f- -~.~ Surface water Curtain drain On adjacent lots ¢/p / Cutbank Driveway, parking/vehicle storage area '*/"//'_.,,~ / Property line To existing or abandoned system on lot Water m~ervice line *~-/~ ~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e¢ec¢~on the date of this inspection. ~.,, * ~7.~~, ~- , , -;:, ,~ Engineer's Name ~---,¢~,¢, ~ ~ Date /~//:~/'~ 5' HAA Fee $ Date of Payment .~ -_~ Receipt Number Waiver Fee $ Date of Payment Receipt Number CE ,'736 72-026(3/93)* Back SEP--19--94 ~ON 17:12 CT~E ENVIRONMENTAL CT&E Ref.# Mat~g Cli'~ntName Ordered By ProjectN~ P~ojeel# PW$ID Commercial Testing & Engineering Co. Environmental Laboratory Services ~e.~.,er~e~rj~r~e~l~'.4r~'l~l~ LABORATORY ANALYSIS REPORT 94.4?374 SAND FILIEa/EARLIIAY LOT26 BLK3 WATER EAGLE RIVER ENGINBERING LAURA WORK Order 82253 Printed l)~t¢ 09/19/94 ~t6:57 bra collectedE~te 09/15194 ReeeJ v~ Date 09115/94 ~14:30 Teehnicsl ]Dix~[or STEPHEN C. EDE 8ample Rera~!~s: ROUTItqE SAMPI,E COLLEC'I~D BY: LB. Parameter R~sults Qua1 Units Method A]tow~ble Ext. Ar, al Limi~z D~te Date lair Nitrat~-N 2.0g mg/L EPA 353,2/300.0 l0 09116/94 CMR * gcc Specifl Instructions Abovo UA = Uaavaila~le ** S~ 5~IcR~s ~ovc ~=Not ~latyz~ U = Un~t~ ~o~v~m is ~c p~ ~tion li~t. LT = I~a lhau g D ~ ~on~ &l~ion' 5633 O Street, Anchorage. AK 99518-1600 -- Tel: [~7) 662-2343 Fax: (907) 561-5~1 ENVIRONMENTAL FACIUTIES iN ALASKA. COCORAOO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY00 HIe, UTAH, WEST VIRGINIA ApPLI( -'NT FILLS OUT UPPER HA[ -- iONLY '~Property Owner ~-~"( ~ '~'--~ ~ ~ e'~ (~ ~ .. ,. Phone Id, ,. c~ ~./ ,~ ~./~,.,~.m.,~ ' Lending Institution ,/~(~'b ~-~' t~/'pet ' Phone Realty Co, & Agent Address Zip Code Type of Residence .~l~'~g lo Family [] Multiple Family No. of Bedrooms [] Other Water Supply ~l'ndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal nd,v,dua, Year ,nd,v ua, ,nsta,,ed: / [] Public ~tility When Connected to Publio ~tility: [] Holding lank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Date Jnsp~tor Insp~tor Insp~tor Insp~tor Field ( ~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE ~QG--~ Y Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (3182) '~7'me . '~Time ,ie ~ -- ~ -'~ Date Date Date Inspectur Inspector Inspector Comments ~¥o~-~ /~0(.,~_~ ~z~/~- CondltionalApproval .......... Date Sewer Installed Permit No. Septic Tank Size [j~ ~ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received ~ ~ ~ Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Dp ~ ~ ~ ~'~ ~ ~ ' Phone Pr erty Owner Buyer Address 2~ ~ ~ -- ~ ~~'~ Lending Institution ~/~ ~ ~ ~ f;'~ ~ ~o ~;~ ~ Phone Address ~~ ~X~ ? ,~'~ ~~ Realty Co. & ~gent Phone Address - ~ ~ ~ Legal Description Z O~ ~ b , ~/~- ~ / ~ ~/ Street Location /~ ~ ~ ~'~ ~> ~'¢~¢~ ~ ~ Type,o~esidence ~Single Family ~ ~ultiple Family - No. of Bedrooms ~ Other Wate[ S~ply ~dividual · ' ~ A~ACH WELL LOG. A well log is required for all wells drilled since June -~'D Community ~ 1975. For W~lls drilled prior to that date, give well depth (attach log if ~ Public Utility " ~, availa~le~ Sew Disposal,, ~ Individual" Year Individual Installed: ~,~.~,~~ ~ When Connected to Public Utility: ' NOTE: THE INSPECTION FE~" MU~ ACCOMPANY EACH R~QUEST BEFORE PROCESSING CAN BE INITIATED, February 3, 1982 Richard C. Sund P.O. Box 509 Eagle River, AK 99577 Subject: Lot 26, Block 3, Earl Ray S/D Dear Mr. Sund: Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: o A well log submitted to this office for our files and " 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. 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. Sincerelyv Robert C. Pratt Associate Environmental Specialist