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Home My WebLink AboutCHUGACH PARK ESTATES BLK 2 LT 16 ~ M~JNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES : Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ^ddress J~ I lC ~, A/--i~I'Z..I ~-HT' ~ SEPTIC ABSORPTION WELL ..... TANK FIELD Phone[s) Permit No. I No~ ol Bedrooms WELL ! LEGAL DESCRIPTION LOT LINE Township, Range, Section / '7~ ,,'" AS-BUILT DIAGRAM (Show Iocatpon of welt, septic system, property hnes, foundabon, TANKS N [~'/SE PTI C [] HOLDING Manufacturer Capacity in gallons Material No, Gl Compartments t....,....__ TYPE OF SYSTEM [] TRENCH E~BED [] W. DRAIN [] OTHER Depth to pipe bottom from Total depth from original grade or,ginal grade ~,5 FT '~" FT Fdl added above ongmal grade Gravel depth beneath p~pe Gravel ,Gng~b Gravel w,dth ~0 X' ~otal absorpt,on area Distance ~tween ,,nes XX ~x Number Gl h~es Sod rating P~pe material ~ ~ ~ Date Installed WELLS ~RIVATE ~ OTHER (Identify) ' Classd~cahon (A,B,C) Total Depth ~ Cased to FT~ FT REMARKS: scale: I" ~' ENG~R'SSEAL Inspections Pedormed by: ~~~__ ~ Health Depadmen, Approval, Date: //-ff 72-013 (3/85) ~..--~ ~ ........ 1311 '"Ir'" "¥" C~ F- DEF:'AR F'MENT HE]AL TH AND ENV I RONMENTAL OTECT I ON ,::,~.,.~ L. STREE-f'~ ANCHORAGE, AK 99501 F:'ERM I T NO: DATE] ,~St I '"-') - 86C) L"' ':3'2. ENG I NEERED DES I GN 09/08 '"' ~ APF:'t_ I CAN'T': ADDRF'SS: M I I<E AL. BR I GHT 22(')0 GLICIER ~.104 ~N[,tE.¢RAUE, AK 99508 L. EGAI ....DESCRIP: L 0 T S I Z E: SUBDIVISION: ~CHUGACH PARt-':: EST. SEC]ION: 1'~',~, TOWNS~.IIF': 15N 54587 (SQ.F'T'. OR ACRES) LOT: 16 BLOCK: 2 R~NGE: 1W I cer'ti['y that: :[. I am £amiliar' wit. h the r'equinements for' on-site sewers and wells as set for-th by the Municipalit..y c)F AnchoPage (MOA) and the State o[' Alaska. 2. t will inst. al]. the system in accePdance with all MOA codes and r. egu].at:i.,:3ns, and in complianc:e wi{h the design cPitepia ~¢ this per'mit. :3. I ~,,:i.].1 adher'e to all MOA.and State of Alaska requirements for the set bacl< dist. ances er'om any existing well, wastewater' disposal, system or' pLtbl:i.c: sewer'age system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTAL. LE;D IN AN AREA COVERED BY MOA BUILDING CODES, ]'HEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILl .... NO]' BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE L'<I...EC'TRICAL WORK MUS'T BE DONE BY A LICENSED ELECTRICIAN. S ]; GNED ~F'F I_ I L. AI.4 f: I SS'UED BY ~. _~_ DATE: //) I DEPTH FORMATION -,~ro- ....... Ira,' ......... -~-/ ,. ....... % ..... : ..... j ~ DE~ r, OF HEALTH & I i K'~*~ ~"] ) ~ - "'~'~i'~ R 'S SEAL) SERVICE~ 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN ~/~ ~ Z C~¢~/¢ ~ownship, Range, Section: LEGALDESCRIPTION: .. / / SLOPE WAS GROUND WATER ENCOUNTERED? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O cp. IF YES, AT WHAT // pO! DEPTH? Monitoring? ~' ( Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND __ COMMENTS /~/' ~'- /'/~';;:~'/'~/-- ('"~---'~¢)' ~J~'/-"J~_ Y ~-, ................ ..~ /~ / P~R.OR~ a~ B 19~X ,~~ o.,.,s 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN 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 264472O Application Date November 7, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ~ot 16: Block 2; Chuqach Park Estates Location (address or directions) (b) Applicant Name Jeff Herlocker Telephone: Home 243-4427 Business Applicant Address BOx 220170, N3chorage/ Alaska 99522 (c) Applicant is (check one): Lending Institution []; Owner/builder I~; Buyer []; Other [] (explain); (d) Lending Institution First Federal Address (e) Real Estate Company and Agent Address Telephone none Telephone (f) I~!t.[k'the HAA to the following address: S & S ENGINEERING SRB 196X Eagle River Road ~ t ~ ~ \\ Eagle River, Alaska 99577 ~ TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms .3 Other WATER SUPPLY Individual Well I~1 Community [] Public !-I 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 I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDII~ INSPECTIONS, TESTS, FILE SEARCH, DA I'A AND INFORMATION ~,s certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this ~ealth 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 S & $ ENGINEERING SRB 196X Address EAGLE RIVER, AK 99577' Date Telephone o DHEP APPROVAL Approved for ~' /~ bedrooms by Approved '~ ' Disapproved Terms of Conditional Apj3roval Conditional 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) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV RECEIVED If A, B, C, D.E.C. Approved (Y/N) Date Completed ~; - 7..-t~ ' ~ ~ · Yield Depth of Grouting Pump Set At Sanitary Seal on Casing {~N) Depression Around Wellhead (Y~ Well Classification Well Log Present/~N) Total Depth ~'"~'~ ltlt~ Cased to ~-.~/ Static Water Level /'~ Casing Height Above Ground Electrical Wiring in Conduit ~/N) Separation Distances from Well: To Septic/Holding Tank on Lot /~r~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line A.Z[ ~ ;.On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole h'~ll~ To Nearest Sewer Service Line on Lot ~.'~/-'/' Water Sample Collected by ._% d-_~ ~/,~ L~, ~E'~it'~,"4 ~, ; Date ./~//,~ ~/~ 0/ Water Sample Test Results Comments ~1-~ ~n ~'[~. ~.~'/., ~ ) B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~3~) Air-tight Caps ~.~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~ -to-~, Size /ooo r...~. No. of Compartments Foundation Cleanout (~N) Date Last Pumped /,4/~ 'for "---'- 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 /o To Building Foundation z. ox To Disposal Field /0~ 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/~I~ /,~- ~/~///~ Type of System Design Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,/oc~/-/- To Building Foundation Lot /~/A To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Length of Field Depth of Field ~ Gravel Bed Thickness ~. 5' Standpipes Present ~..~/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,~ I"/" To Cutbank (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 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 MOA.and HAA~quidelines in effect on the date of this inspection. ~ S & S ENGINEERING -. ~igned __ _ uate _ Compan MOA No ~GLE RIVER, AK ~95~ ' - ~eoeipt No.~~ ~~ ~ .. ~ .~-~L Date of Page 2 of 2 72-026 (11/84)