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Home My WebLink AboutFALLING WATER BLK 3 LT 4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 I_ Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPR°NE I MAILING ADDRESS LOCATION NO, OF BEDROOMS F,41e ~ Well ~ ] Ab~rpt on areaz : Dwelling ~ PERMIT NO o - / DISTANCE TO: I I O0 ~ I A ~'~ ' ~0 ~Liq, c~q)acity in gallons Inside length ~ ..... L aO~ I DISTANCE TO: lwell IDwelling__ / IPERMITNO' ~ ~ DIST/ ~WeH _ f-- Foundation ~ ~/, INearcstlotline ~ ~ Z I No. of lines / ~Length of e~int Total length of lines] ~r,nch width ...... ~ [Top of t le to fin~sh grade . I M~ter~albeneathtik, - - ~al-~f~tiveabsorptionar~a~ . I ~ngth IWidth Dtpth/ I PERMIT NO. ~ ~ ~h - - ,~ ...... I ....... ~ ~ I Type of crib ~Crib diameter ~i~d~pth /Total eflective absorption area ~ ~C[ TO ell ~ foundation ~em'est ~ Icmuss ~Depth Driller ~Distanc~ 1o lot line PERMIT NO. ~ I DISTANCETO Buildingfoundation~ ~w~.~ ~ ~ ~ /Se~tioto,,k Absorptionarea(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS A P P,/// IDOC Co. dba SULLIVAN WATER WELLS P.O. BOX272, CHUGiAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND , .~'~'~a._~,~ ADDRESS ,~/9 ~a ~4 DEPTIt OF WELL LEGAL DESCRIPTION .~/ ~/ a~'r'< i] DATE- Started L~7/2c 2 Ended PE~IT NUMBER STATIC LEVEL OF WATER FT. (~ ~ DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From d9 Ft. to. ~ --Ft O ~/.-~,~;,~-,;/?~.~,~, .j From ,~. FL'to ~ ~ Ft. <~< ~ 7~ ~.~ ~ From Ft. to__~Ft. ~'-~o ~ ~'~ 7 From. C)~Ft. to~C/ Ft. C~-~ X.¢~c~x From,, Ft. to Ft. ,~/ ~' ~=~ From./ /0 Ft. to //:~' Ft._ ,~/~ ~ From// ,~ Ft. to ] ) ~ _Ft. ~ gdmo,-d-d.. ~' Fromm_ Ft. to .... Ft. ~O~ From Ft. to~_Ft._ From Ft. to Ft From_ Ft. to _Ft .' .:,.:.: r From_ Ft. to _Ft __ From .Ft. to __Ft, From._ Ft. to .Ft. From__Ft. to __Ft. __ From .... Ft. to ...... Ft. From Fl. to From _Ft. to From Ft. to From___ Ft. to__ From_ --Ft. to_ From _Ft. tb From.. Ft. to_ From ..... Ft. to From __ Ft. to__ From ..... Ft. to__.__ From Ft. to ¸Ft. _Ft. Ft__ .Ft, .Ft, Ft. Ft MISCL. INFORMATION: DRILLER'S NAME ..~ ,~ '= C~,,"-/ 7'~~ PERMIT NO. MUll I CIPFILIT'~ OF FI~ICHORFIGF DEPARTMENT ( HEALTH AND ENVIRONMENTAL DTECTION 825 ~L STREET, ANCHORAGE, AK. 264-4720 L4ELL I'qe4D E,~4--SITE SELqER PERMIT 820820 ) APPLICANT DR ANDERSON SRA BOX 2415 E.R. 99577 LOCATION 1 LEGAL L4B FALLING WATER LOT SIZE TYPE OF SOIL ABSORPTION SYSTEM IS~ TRENCH 694-2661 999999 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR>= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DFPTH I 0 LFNGT| |-~ 22 GRAVEL DEPTH= 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 EXCHVATION (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>. RE[J~IJ I RED SEPT I C TANK S I ZF--- 1 000 GALl ONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTBLLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERME. T~40 ( 2 ) I ~'4SPECT IONS PRE RE[~U I RED 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 PRIMATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS 8ND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PFRr4 I T ,F×P I RES DECEMBER --?-1., 190::~' I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS 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 REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. SIGNED: APPLICANT DR ANDERSON ISSUED B ~rL .L' ' ~'~ ~_ >2~ ~?/L~_~FI T E ..... V4. 0 Lo~Rrxo~ 4~ · TWaE OF _~0[L ~TION ~TEi~ 15: ~ TWO <: ~ _-) I NSPFOT ION$ FIt~E REt.~U I RED BRC~FILLI~ ~F P~Y ~T81 WITHOUT FINAL [NS~ECTI~ ~N~ ~ B~ TNI~ C~J~TM~NT WIU~ BE SUbJeCT TO PR~5~JT%O~ PFRMIT E~P-IRE~ OECENBER ~ ~ l~B2 0 8-E CO. GEOT~CHNICAL ~ DEVELF'DMENT Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils ~- Foundations Lend Development PerfOrmed for: Name: Hatltng Address: Legal Description: Soll Characteristic) Depth (feet) ~7.5 r,q.. 3 5 , 6 G',~' - £a~dy G'ca¥ol ~ith c, obb!~s to ,..~ inches in V~'~? etaan and loose tm~t,.~z'ials. $5 sq. ft,./~ro 85 sq. ft,/Br, 10, !1 12 ~6 G~,.I - $~ndy Gravel with aoSbl~:J to 24 inehss in ~.i:~meter, i3ctt~.~ra of pit. Ground Water Encountered: Yes Proposed Installation: Seepage Pit__ Drain Field .':'~ Performed by: Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl TH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CEflTIFICATE OF INSPEQ ~ION FOR HEAl_TH AUTHORITY APPROVAL OF ON-SITE L;EWER AND WATER FACILITY 264-4720 Application Date ~ ~'~/___ _Z""~~ _'... JS_ ...... GENERAL INFORMATION (a) Legal Description (include lot, block, subdlv~siorh section, township, range) l...ocation (address or directions) (b) Applicant Name ~,~.._~P_~_-_~6~'/-~ "lelephone: Home ~¢~--%¢I-~_.._~_ Business Applicant Address %~ ¢- C~. ._~A_.__~¢_ ~?-/¥ ~.:?¢ _~_~_~:::_'~_____~ v~_~._[___Z~>_~ , ..................... (c) Applicant is (check one): Lending Institut~¢¢n I']]; Owner/builder,~ Buyer []; Other [] (explain); (d) Lending institution ................... Telephone Address (e) Real Estate Company and Agent .. .............................................. (f) Address . Telephone .... ;M.~'ffhe HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Other Number of Bedrooms .... WATER SUPPLY Individual Well~ Cornmurfity [] 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 Onsitel~ Public [] Community [] Holding Tank [] Note: If community well system, must haw; written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025111~84) ENGINEERING FIRM PFIOVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certilied by my seal affixed hereto and a,'-; of the validahon date ~hown [)eh)w, I vnrify that n,y investigation of this Health Authority Approval shows that the on- site wrder supply al id/or wastewatur d~:4)os~aI ',;ystn mi:; safe. functional and adeq ;ate for the r'lurnbor of bodlooms and type of structure indicated harem. I further verify that bar, od ou the mlormahon obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-s~te water r,upply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinance:}, and regulations in effect on the date of this inspection. Name of Firm . DHEPAPPROV~..~r_//,__ / Approved for ~'~.____"~-~ ._~.~.bedrooms by Approved ......... _ ~"' ___ Disapproved 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 Anchor,'age is not responsible for errors or omissions in Ihe professional engineer's work. Page 2 of 2 72-025 (11~84) WELL DATA Well Classification Well Log Present ~/N) Total Depth [ Static Water Level Casing Height Above Ground Electrical Wiring in Conduil~[~/N) Separation Distances from Well: To Septic/Ne!d!ng Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Descr,~tion: If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ - 8'7--- ~'' Yield Cased to ~/~ Depth of Grouting Pump Set At Sanitary Seal on Casing~:~N) Depression Around Wellhead (Y,~[~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots L~ To'Nearest Public Sewer Line ~'J //~ To Nearest Public Sewer Cleanout/Manhole "~ /~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~'~!~'~' ~'~'~ ~¢..5~==~=~_~,._~ 4.. ; Date ~ Water Sample Test Results Comments ~ ~,,,J~e...~... ~/( ~ -I'"~----'<~'T'"~ t-~-J~__~-~ -r~ B. SEPTIC/H~t~'Dffff~ TANK DATA Date Installed J~-.:~::~-.~ Size Standpipes ON) Air-tight Caps~N) Depression over Tank (Y/~J~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/~o!d!ng Tank: t To Water-Supply Well ~, c:,~..~ A,- To Property Line I ~ t ~. To Water Main/Service Line 1¢-~ fA-- Course "J No. of Compartments Foundation Cleanout~'~)N) Date Last Pumped , 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) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~-~ ~ ) Type of System Design Date Installed '~ ' ~ ~ ~"~" '-'/ Length of Field '~-'7,~ ' & t Width of Field '~,c:~ Depth of Field Gravel Bed Thickness r'7 Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: Standpipes Present (~N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot ~ To Water Main/Service Line I To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line t ~.~ ~ ,4-- To Existing or Abandoned System on ; On Adjoining Lots 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 M/OA an/d HAA guidelines in effect on the date of this inspection. ............ '~'~'~ Date Signed ~i o. ~: MOA No. ,~,_.~--O SRB lg6x C°mp~a,,n~LF. ~iVF. R, A',.AC,~'.A~ ~ PH, 694-2979 Receipt No. ._'T~% 7,.1~ [O Date of Payment ~0-'~-~5 Amount: $ "~ ,C)O Page 2 of 2 72-026 (11/84)