HomeMy WebLinkAboutBENSON LT 1A
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
~'~.-, ~--~,A, ~ ~~ 0~, ~ ~0 S~PTIC ABSO"PTION
A~~ WELL
~ TANK FIELD
Phone(s,~ ~ ~~ J ~ ~ ~ ~No.'o' B~droo~s~ WELLLoT LINE
LEGAL DESC"IPTIO"
FOUNDATION
Township, Range, Section
~~ ~~ [ ~' ~ dr,veway,AS-BUILT DIAGRAM (Sbow Iocabon of well, septic system, property hr, es, toundat,On,water bod.es, etc.}
TANKS
Manulacturer Capacdy ~n gallons
'~atenal ~o. of Compartments
TYPE OF sYSTEM u ~ .~'
~TRENCH ~ED ~ W. DRAIN ~OTHER, ~7
Depth to p~pe bottom from ~ota~ depth from original grade ~'. , ~~&
FT , T
FiH aaded above oegmaJ grade Gravel Oepth beneath p~pe
~ FT ~ ,~ FT
Gravel length
~otaJ absorption area
Number gl I~nes Pipe material
~~ ~~ D'te Installed ,~ ·
WELLS ~
~RIVATE ~ OTHER (Identify} '"l"
c~,~,~.t,o,(~ To~U~p~h J C.~dto ~ ~.~
Date Installed:
REMARKS: ~' '
Inspections Pedormed by:
I
Municipal an, StYe guidelines in ellecl on this date: , / / ' -
Health Depadment Approval: Date:
72-013 (3/85)
E. ng :i. r"~eer'. Des :i, gr'~ed
Name: (..~LASKA LJSA F'Ii)ilDRAL.. t'.]REI)t'f' LJNIOIq
ANCHOt'.:~:AGIE!, AK 99519
Day F:'h or'le:
L..o't. L..ega 1: Sub d .i. v :i. s .i. (2n: BIENSON I....o't.: 1..-.A B J. c)c k:
~ii~ec::t'.. ;[ or't,1 2i'.5 ']"C)Wl-i:]th ip: 15N Range:
I...o'l:. Size 1,, 0 A (sq,, f't,, (::)r ac:r. es)
Max E~eclr~ooms~ 'Th:Ls t:::'ePm:i.t~ 4 'f'c,t.a.~ Capaci'l:.y: 4
!:i!~iEF) T :[ [; f'AIqK J~ M :i. n :i. mum t o'L a ]. sel:::,'L :i. c t:. an k ,'.:: apac :i. 't.. v: J., 250 ga 11 c~n :!~.~, Each sep'L :i. c
'Lant.:: must have at ].east ;'::~ coml:)ar.t..ments,, Depth 'Lc:) 'Lop c,f septic: tanl.::(s) < 4,0
f'e(-':.~t Pequ:Lr'e.s :i.i'"~sL~].at:[c]r-~ ,;::)v(.:.:,.~l~ 'l'.ar"~k (.'..~i),,
J. lqb'f' [~I._L. i'::'ER ii:.']qG I f",llii. Ei:RS 'DES :1: ()~l'q ,, ~() :1: SC;Ot'~,IIEC] 't E, X I ST I htC':'i D I S[]"IAIq:GE I:::' I F'E.
~"i;:;:EIi"J I'll~: 4 E{EDt::<CJEiI~I D!.,gl~J....J..J:hlG A1 r ] ;1:1''11/!: OF BED ;[I"'IST'ALLF~'I'ION AND t::'LUG
L...L }",ILL ,, iqC)'l' Z F:' Y DF'IHS PI::,'. ]: OR 'f 0 E;At]H t htSF:'I~/:E;'I' ]: ON ,, '1' H ;[ S I:::'!ERM I '!
~, X.t":' '1: RI:' :~ 12:/:5 1/"8{~) ,,
,1: C1!!:.t'(¢ It;:'Y IHAt:
f(:.,p/:.h b',/ 1:.he M..~rt:i.c:Lp~:',].:i.'t:.'y (::)~ F:)r/cl"~c)r'a(;~(.:~ (MOA) and the ,.,~L.,u~te c:)f A,I. aska,,
,::;. ,, ~ (4 :i. ~. ! ~, f ::, c.a ]. ]. 't:.J'"d".*::' ii!~y'i]i'l:,.E.)tft ]. I'] .:7:~£::C:E)1''~ cJaFJc:f::..) t.¢ :j. 'Lb E~ ], ]. 1't( f...~ c(::~(::h.:.::,s ar'~cl r.e.,gu
arid ici c::,'.:::,r~ip]. ;i ,'::: J"'., f:: ((~: wi't'..h 'LJ"l~'.;:.) desigr:'~ ct' :i. tei" :i.a of 't,h :i,s per'mi'l:.,,
:5,, :1: w:i.].l adh(.::':r'e 'Lo ,aJ. 1 I'.'IE)A and St:,a't'.,e ~,::){' ~:l.a:i!it.::a r'equ:i.r'ement.',.i~ far' 'L. he set back
(;;J :J, st. ai'] I:::J(':',~!~; ~' J" (;:)i'i"l ,','¢i,I"iy (:",~>( ;J, st :[, I")(~,.]. I.,*g(,~.? ], ]. !; wastewater' d :L sposa 1 system or, puL, :l, :L c
· :'!ih?.,,'.4(~.,~r'ag(.:.~ sy![FL,:-:,h'n c:.~n 't,.his cH'" any adjac:ent or, near'by
4,, :[ L,uqder'st, artd tl"tat. 'Ll"lis i::)er'm:i,'l:, :i.s va].:i,d .l:r,:)r, a ma;..'.:i, mum
,::'~. ,1, ~.~(:) LH"H::J[.:.~P '~iii'l:,,(.~[~,'~ 'Lhat 't..he capac: i ty c, f' thr:,,~ 'f,. E)'IL ,.':':'i ], Sii'y'~.L'4'l:,,effl :i, S~i 4 bedr' ooms and
aJ~,,, er')l,~,:.m'~'A','~tl w:i.,Ll r'equ:i.r,e art add:i.t:i, or~al per, m.i,t.
S :i, !:,!~ ~ ........ ........................ .t.)~ 11 ...... .......................................
~ ,, ~ - , ,,~ ~ ~,,~ , ,~~,~ ~ ......... ) ....... ~ .............. \ ..... .\ '
LUWt'H-::.:I') Rt,...Acff'..AI..t,.:~A I'" [::. ].. P~ ("q .... L.,I'd::.D].I LJIIJ. UI.t/r
SCALE
~e 7~
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL OESCR,.T,ON: L--~' t --~ ~
1
2
3
4
5
6
7
8
9
10
11
12
13
Township, Range, Section:
SITE PLAN
SLOPE
14
15
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED7
S
L
IF YES, AT WHAT O
DEPTH7 p
E
Depth to Water,,~ ,
Monitoring? ~'"~/ Dale'. tl~'~.C)-~:)B
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FTAND ~FT
COMMENTS
PERFORMED BY: I
ACCORDANCE WIT'H ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
DATE:
MUNICIPALITY OF ANCHORAGE '
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCAT,ON
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
DISTANCE TO:
Manufacturer
DISTANCE TO:
Manufacturer
HOMEMADE:
Well
DISTANCE TO:
No. of lines ~.
Top of tile to finish grade
Length
Type of crib
DISTANCE TO:
Class Depth
DISTANCE TO;
OTHER
PiPE MATERIALS
Inside length
Foundatio, n 2~
Total length&l~ ~ ,~
Dwelling
Mat~ ./~(~
IWidth
NO, OF BEDROOM~.~
No, of compart~n~
Liquid depth
NO.
inches
Liquid capacity in gallons
Tota ¢¢
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Distance to lot line
Septic tank
SOl L TEST RATING
INSTALLER
REMARKS
APPROV DATE LEGAL
72-013 (Rev./3/78) /
by
DOC Co. dba
SULLIVAN WATER WELLS
P. o. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 68fl-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
PERMIT NUMBER
Ended
DEPTH OF WELL ; /
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From ' Ft. to
From . Ft. to .'
From '- Ft. to- Ft
From Ft. to Ft
From Ft. to ," '- Ft,
From Ft. to
From Ft. to Ft.
From Ft. to__Ft,
From Ft. to Ft~
From Ft. to Ft.
From__Et. 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
FroWn
From __
From
From
From
From
From
From
From
From
From
From
From
From
From
From
Ft. to
Ft. to_
Ft. to
Ft. to
Ft. Io
Ft. to
Ft. to
Ft. to
__ Ft. to
Ft. to
.Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
Ft. to
.Ft. to
.Ft
Ft.
Ft
Ft.
Ft
Ft
Ft.
Ft.
Ft.
FtMUNICIPALITY OF ANCHORAGE
Ft DEPT. OF I: ?,kTk{ 8,
I=NVIRONMENI'AL ?,_O fECTION
Ft.
APR 1 4 1980
Ft,
Ft. ]~12 C I21~,l r n
Ft.
Ft,
71ISCL INFORMATION:
DRILLER'S NAME ' · ...... : "~J " ·
'Tlhe ].e'r'~g'i:h d:ilmen~:i.c,i'l :i.~!. 'the :l. engt:h (J.n i~ e e l~ ) (] ~[; '~2he I(:PI;':'ilCh (:)1" dr'a:L'n'F:i, eld,
The dep'N'~ o.I':' ,a rtr'r..vr:ch (:ir' p:i.'t :i.s; 1ff'm ,':l:~sF'canc:e b~:~"f:~een 'the smr'H3(::e o-F' 'the
,;1r'c, und ~:¢md 'the bo'tt:om o-F 'i:l"m ex c.~v,'~'t J. cn'i ( :i.n Tee'i:) u
J'J"~¢r'~, :i. fi no t~ei: v~ri. di:h .For ~'ct-,t~,flches.
The ¢i"~i:!ve;i. dep'i:h :i. 5 -(;I-le YR:i. Yl:~i~'lt.~fft dep. i:h o'f: gr'4!we], l::..,.~!'~::vcee'n '{:he D~t'(:.i':'..?:i].;t. i}J.l;i(:,:
and 'i:i-'~, l:> ¢ 't "i; [m'~ o't:' t;1'/(!.? exc:,'~w~:a-l:J.o'll (:i. ri Tee'i:),,
[ c i((, p i: :i..F y i- l-',a
'.:; :!Z am .¢am:( I :i. ar' ~-~:L th i:l"m r'equ:i.
~ :I: ~,~¢&].:i. :i. nsFi:~].i 'the sysi'tem :i.n a(::copd,:,mce ~.~:i.i:h 'the cc, des,,
&I::~F)I.-ZC/~,N']'' ..'J'E}i'tFi ,.T,, I-'IAIqIqZ(}iA:N
:].: ]: I::i1"! F:F!il'IIL. IFI!::~: HI-FI-.! TI.lIE: t:;[:EC~Z.!IREEHEI'.,!T:-:!; F'OR ON-...:i!i;IT[E ~i:;[EH[!!ZR~ FIN[) H!iL.LS
FO[R'f'H E~"r' ']TtL:: PILtN]:C):PF~[_IT'Y CtF:
;~.i:: :[ HILl.. ]JN'.:!;TFIL. L. TH[i: ::i;"?:::';T[EPI IN F!CCOI::?.t)F!NCE~ NZ]T'! 't'!'IE~
::i:: ]: IJNE:,E~Iq:~:TFtI",!E:, THF:tT TIlE ON"qJ~ZT[i!: ~;EH[ER L::Br':E;'J"iEi'"I F!Ft? IR[!i:I.::!UIF?.E [/!qLFff:i:G[i:HE:I",?!-
Fi:[!:'_:~]:I')[!i:i".!CE :[:~; F?.EHODEL[E[)'['0 ]:NC:l._U[::'liii: P'iORE:, 'TT-ff::li",i Z
kJ~::'F'L i C:I:::ff',FI" L..drI~.)H,Ki ..:r. I t~: ~ES]:~J ~]~I~,L.~
/
O &,E ENGI,,~EERING] & DEVELoF''~iENT CO'
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Performed for:
Name' ,/~/~
Mailing Address:
Legal Description:
Depth (feet)
1__
2__
8
10__
11__
13__
14__
15__
16__
Soil Characteristics
PLOT PLAN
PERC. TEST
£
Ground Water Encountered: Yes
Proposed installation: Seepage Pit
Comments: /~,~'-~"-~--"~ (
No___ If yes, what depth
Drain Field ~
Performed by: ~t .z~.,,~ %.._ ~)y .~¢Z-~'--,/Z- Date:
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
,~) ~'~"'/-/~/- ~ ~ HAA# ~:~ (~'~- ~-~ ~ ~:~ -'-~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~ 0~-~,/~'
Mailing Address ~,, ~, ~
(c) Lending Institution
Telephone ' (home)
Business
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here/l~
hold
for
pick
up.)
List contact person and day phone number below:
17034 Eagle Ri~er Loop R~ad Ne. 204
2. TYPE OF RESIDENCE
Single-Family"~ Number of bedrooms z:~
3. WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site/~ 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.
72.025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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.
Name of Firm Telephone
S & S ENGiNEERiNG
Address -,~u.,.,--,, ' ~,-~"-'. ...... mvA~-Loe~ Road No. '~t
Date Eagle River, Alaska 99'77
6. DHHS APPROVAL
Approved for ~--c~z(~_~ bedrooms by~ ~ Date ,
Approved Disapproved Conditional
Terms of Conditional Approval ~'~~.' ~ ..--~.~..~.~c' ,~ ~. -
-4..,,_, .
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
~:] MUNICIPALITY OF ANCHORAGE (MOA)
~.~,(e~__~ ,~ Health Authority Approval (HAA) /'~
,~,~;~' ~.%'~'=~'~?'.~:-' CHECKLIST - FEBRUARY 1984
~,~ ~,.
~ ~ ~j~ ', "~'~ ~ ~ 343-4744
.~ ~ "~ Legal Descnphon: ~
A, WELL DATA
Well Classification
Well Log Present ~N) '~/ Date Completed
Total Depth ~ ~ ~ Cased t~o
Static Water Level ~-.~
Casing Height Above Ground
Electrical Wiring in Conduit~Xl)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field o~ Lot
To Nearest Public Sewer Line ~-~
To Nearest Sewer Service Line on Lot
Water Sample Collected by '~'~'~
Water Sample Test Results
Comments-/~r- ~.-,,d:,-~t ~.., ~,~_---,.~.~
If A, B, C, D.E.C. Approved (Y/N)
Yield ~
Depth of Grouting ~
Pump Set At L~
Sanitary Seal on Casing~ZN)
Depression Around Wellhead
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'2.~-~ Size
Standpipes (~/N)
Depression over Tank (Y~]~J
Pumping/Maintenance Contact on File (Y/~N)j
Holding Tank High-Water Alarm (Y/N)
No. of Compartments
Air-tight Caps~N)
Foundation Cleanoutd~)
Date Last Pumped ~
/~L~. ; 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
To Stream, Pond, Lake or Major Drainage Course
To Building Foundation
To Disposal Field
Comments
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field \
Square Feet of Absortion Area
Depression over Field (Y~
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ~
Statndpipes Present
/Date of Last Adequacy Test
I
To Property Line [~
To Existing or Abandoned System on
!
; On Adjoining Lots
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 Cutback (if present)
Comments
· s.^.,o.
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump fOj.~ Level at
Vent (Y/N) ~.-.._
Pumping Cycles during Adequ~
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed S & $ ENGINEERING
Company
Date
M°A No.'
17034 Eagle Ri~er Loop Road No. 204
Receipt No, ~O~c~-- 2 C/-7'//~ (7/)
Date of Payment //('~ -/-cF'- ~ '/
Amount: $ /~D 0 0
Receipt No.
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
ROBERT A. SHAFER
December 8, 1988
CIVIL ENGINEER
694-2979
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
MUNICIPALITY OF ANCHOP, AC~E
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
Municipality of Anchorage
Department of Health and Human Services
825 L. Street
Anchorage, Alaska 99501
DEC 81988
RECEIVED
Reference: Lot 1-A Benson Subdivision
The septic system serving the garage will be abandoned by
September 15, 1989. The garage structure will be converted to
garage use.
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
The existing well and new septic system will only serve a four
bedroom single family dwelling. This commitment is in accordance
with the con~li~of the permit issued by you and consistent
w~th ~3~ning of ;his area.
~afer, P. E
cc; Ak. USA Federal Credit Union
Finis Sheldon
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577