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Home My WebLink AboutCHANDELLE ACRES LT 22 MUNICIPALITY OF ANCHORAGE DE, ,tTMENT OF HEALTH AND H'UMAN SERk .~S Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name A~_~ss Phone(s) I Perm,t No lNg. of Bedrooms Township, Range, Section LEGAL DESCRIPTION TANKS DISTANCES TO SEPTIC ABSORPTION WELL TANK FIELD LOT LINE FOUNDATION ~ AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etcl ~ SEPTIC [] HOLDING Manufacturer Capacity in gallons Material No. of Compartments TYPE OF SYSTEM [~ TRENCH J~BED [] W. DRAIN [] OTHER Depth to p~pe bottom lrom Total depth from ongmal grade or,gmal grade 4 FI 'Cf" ~'F'I' Fill added above original grade Gravel depth beneath pipe Gravel length Sravel w~dth ~ FT Total absorpt,on area ' Distance between lines I L~'"~;~O SO FT P,pe mater,al Numbe~r t~l,,r~es i so,I rat,.g installer Date Instal ed WELLS ~ PRIVATE Classdlcatlon (A,B,C) [] OTHER (Identilv) Date Installed: ~~ FT REMARKS: Health Department Approval: Scale: Inspection~eO by: certify thalthis inspection was perlormed according to ali ~ ~ , . 72-013 (3/85) DEPARTMENT OF HEAL/TH AND ENVIRONMENTAL. PROTECT I []N 8.=: ..... L. STREET, ANCHORAGE, AK 99501 ,~.64"-'4 F'ERMIT NE: DATE I o,:) .~ED. 85()473 08 t()6185 -,r" r' L I CANT: · ') , ¢~..t:, ADI..RE~S: C.[.N T ~.~C I F'HONE: 7. ="e.x.c"~ ENGINEERING LARRY WEHR SRB 196-X EAGLE RIVER, Al'.':: 99577 694-29'79 I....EGAL. DESCRIP: t_..0 T !3 1 Z IE:: ~IAX BEDROOMS: SUBDIVISION: CHANDELLE ACRES SECTION: 3 TOWNSHIP: 15N 51200 (SQ.FT. OR ACRES) 4 LOT: 22 BLOCK: N/A RANGE: 1W I_isted below are the options available to you in designing yOLtr' septic system. Choose the option that best ¢its yoLtr site. -IF R E: N C ~-~ I~£¢ E D W - I) F~ A DE:PTH TO F'IF'E BOTTOM (FT.) GRAVEL.. DEF"TH (F'T'.) l'01'AL.. DEF'I'H (FT. ) GRAVEl .... WIDTH (F'T'.) GRAVEL L.E:NGTH (FT.) GRAVEl .... VOLiJME (CU.YDS.) T'ANK SIZE (GALS,) SOIL RATING (SD.FT. /BR) 4.0 4.0 4. () 4. () 0.5 3.5 8.0 4.5 7.5 2.5 27.0 5..0 134.0 ** 54.0 116.0 ** 55.9 54.0 86.0 268 239 268 ~* GRAVEL LENGT'H > '75 FT. REQUIRES MULTIF'LE RUNS (NOT' EXCEEDING 75 FT'. EACH) ** TANK MLIST HAVE AT LEAST TWO COMPARTME:NTS I cer'ti£y that: 1. I am familiar with the requirements for on-site sewers and wells as set f'orth 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 o[ this permit. 3. I will adhere to all MOA and State o[ Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewePage syst. em on this or any adjacent or. nearby lot. 4.. I understancl that this permit is valid £or a maximum o£ 4 bedrooms and any enlargement will require an additional permit. IF A LIF'T' STATION IS INS'T'ALLED IN AN AREA COVERED BY MOA BUILDING COl)ES, THEN (1) AN EL. ECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUIL_TS WILL. NOT BE AF'PROVED WITHOUT AN EL. ECTRICAL. INSPECTION REPORT; AND (3) THE ELECTRICAL. WORK MUST BE] DONE BY A LICENSED ELECTRICIAN. APPL I CANT': % ~,:~ I NEE:R I NG ~7-1R PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~' ~,-.,~ SLOPE Township, Range, Section: WAS GROUND WATER ENCOUNTERED? SITE / S IF YES, AT WHAT ~J (~ DEPTH? ~ Depth to Wat~ Moniloring? ~ I I I'~. Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE '~"q (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN "~ FT AND ~ FT COMMENTS ~V'J .1~. W~" 5; ~,~,,~"7~ L/.. ~'"',~ / .~"~.~,, .,~;~" PERFORMED BY: ~ _~. ~.,~ R~/~ ~.' ~S;~I C.~:~7 / ~~ / CERTIFY THATTHIS TEST WAS PH ~C4 2979 .... PERFORMED IN ACCORDANCE WITH ALL STATE AN"D' MUNICI~'~UI~ELINES I" E~ ON THIS DATE. DATE: 72-~8 (Rev. 4/85) ( eriifiei Drilling og b.~ [DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 668-2759 OWNER OF LAND ADDRESS . DEl'TH OF ¢;ELL / ST-xTIC LEVEL OF wATER [:'[. ~c~ :,x LEGAL DESCRIPTION DATE - Started :' / PERMIT NUMBER q~? Z)~ c ~ I)RA~; DOWN FT. Ended /~;-f' ¥ ~ GALS. PER HR KIND OF' CASING KIND OF FORMATION: From__ From From ..~ From / From__ From_ From__ '~ ~ From Ft. to Et. to i ¢/ Ft Ft. to .Ft. ,:o~ ~ From~Ft. to~ Ft. to Ft. ~ ~7/~. From ~FI. to~ From ._Ft. to__Ft. From~ From__Ft. to Ft. From~ From__Ft. to____Ft. From__ From~Ft. to__Ft. /h ~i"'h~\'"~'"} From__ From _Et. to Ft. k.j~ From From Ft. to.__Ft From ~ From__ Ft. to___Ft. From__ From Ft. to Ft. From__ From Ft. to ____ Ft From Ft. Ft. Ft. Ft Ft. Ft. Ft. Ft. to Ft. Ft. to~~:~ Ft. to__F~.'~ Ft. to__Ft. Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME "'~f 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) (b) Applicant Name [--~1~ ~ ~ Telephone: Home ~::~'"~:~Z-t'~ Business Applicant Address ~::~:~ (c) Applicant is (check one): Lending Institution [] · Owner/builder~; Buyer [] · Other [] (explain); (d) Lending Institution ~" Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SRB 196X EAGLE RIVER, AK 99577 TYPE OF RESIDENCE Single-FamilyJ~ Multi-Family r'l Number of Bedrooms ~ Other WATER SUPPLY Individual Well I~- 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,~r. 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 I of 2 72-025 (11/84) E~IGINEERING FIRM PROVIDt._ .~ INSPECTIONS, TESTS, FILE SEARCH, D,-, I'A 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. $ & S ENGINEERING Name of Firm SRB 196X Address EAGLE RIVER, AK ~:)577 Date Telephone Approved for ~ bedrooms Approved f Disapproved 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 (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 NiU; ;iCl?ALIT/ C,F DEPT. O? fiE,".L?,.J 7.. Description' Legal WELL DATA Well Classification ~-'~.~'- If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N) Date Completed I._z~ / ~:~ Yield ~1~0~ ~ ~' Depth of/Grouting "-"- Total Depth t.~;K~' ~e~ Cased to Static Water Level ~'"2,. ~ Pump Set At Casing Height Above Ground "~'~='# Sanitary Seal on Casing (~N) Electrical Wiring in Conduit I~/N) Depression Around Wellhead (Y~) Separation Distances from Well: To Septic/I-~et~i~J Tank on Lot [ O~=" · On Adjoining Lots ! . Lot 1, t c:~ · On Adjoining Lots To Nearest Edge of Absorption Field_~,n/ To Nearest Public Sewer Line r,,/,j~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Sewer Service Line on Lot ~ ~' ~ '~ ~-~ I~--t-Y~lr,.~¢~t¢=i~l,,~ ; Date ,~' "~" ~ Comments B. SEPTIC/~,OJ.-~tI~'FTANK DATA To Water-Supply Well To Property Line To Water Main/Service Line Course Date Installed ~.O-'Z~- ~ Standpipes ~)'N) Air-tight Caps~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/I-.~el~g Tank: I Ot~s Size ~'Z.~Z) No. of Compartments Z. Foundation Cleanout ate Last Pumped /D 1t~' ' for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~'""~':'~ Date Installed [Lc) - '~""~ ° Width of Field "'~ Square Feet of Absorption Area Depression over Field (Y~]:) Type of System Design ~'~1~ Length of Field I~ ~ Depth of Field Gravel Bed Thickness Standpipes Present~/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: ~ ~, c~ To Property Line 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 To Existing or Abandoned System on · On Adjoining Lots ~ t To Cutb~k&(if present) Comments D. LIFT STATION 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 /"~/A Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify.thi~t I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & S ENGINEERING Date MOA No. Signeds~ B 196X C°mP~GLE ~i~/ER, AK 9957-/ Receipt No. ~/oO 1-00.~ '~ Date of Pay ment ~ ' ~ 5 ~ ~ Amount: $ ~ ~ Page 2 of 2 72-026 (11/84)