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Home My WebLink AboutT15N R1W SEC 19 LT 17 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 NAME MAILING ADDR LEGAL DESCRIPTION LOCATIQN ~; "'~ ~ ~1Woi~ ~ Absorption area i DISTANCE TO: Manufacturer IF HOMEMADE:Dwelling Inside length Well No. of lines Length of each hne Foundation Top of tile to finish grade Length Width Type of crib CHh diameter Well DISTANCE TO: DISTANCE TO: Total length of lines Material beneath tile Depth Crib depth Building foundation Depth Driller Building foundation Sewer line ~o~ ~J~EW P [] UPDRADE Material Nearestlotline 7~ I Trench width "~L.~ inches inches NO, OF BEDROOMS PERMIT NO. Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO, Dist a n ce~et./wj~ lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Septic tank Distance to lot line PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS INSTALLER REMARKS APPROVED DATE LEGAL 72-013 (Rev, 3/78} ~/"t¢~7 ON SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION DIs'rAt;CE TO: [ ~ I OTHER PIPE MA'/ERI&LS ........ /~B 3~ INSTALLER lEGAL f::l F:'l::'[ .. ]: C: F:l N T r~:FILF'H LL'IFFIT]:II)II-,I I:EFt'Z-." CIF' E:,FII",IN'T' I_.EL-iI:IL. II..:JG:? :E;EC: :l.~ii~ ""[ J.. ~--' .'=3,q.~:l:SE:.l E;L.EHJFII:~:E FEET HF:I;:-;;II','IU[',I N,L.IHBEI:;;'. CIF EEZ,I:;"Z'£[','I'_: := ~: ...... I HIII',I.: Ff._,l:... .... TIdE I:;i:EI:;:II,..I]:I:~:E[) E:;]:ZE CfF THE :SC[ZL. FIE, E;CRF'I ![.L!q c';"r'L:.';TEH "I'IaE LEII',IG'I'H D, iMIEf',!:SION ]:L'7, THE LENGTH (ZI'4 FEET:) OE ERCH E;II}E I::'OR FI '_"~;EEI:::'RGE PIT. THE E:,EI::'TH OF R TF;'.ENCH OF..' F:':ET IE; THE II> :[ E;TRNC:E E:E"FII,.IEEN THE 5I_.II:;~:I:':'I::IIZ:E L-IF 'f'HE I:3:F,..:OUND FII'.,IE:, THE E:OTTOf'I OF::' THE E';.::CI::IVI:a"FIOIW ,:II",l FEET>. TI:.IE C¢::~'.F:t'v'EL [>EPTI:t ZE; THE f'I!II.,t!HUH DE:PTH OF: GI:;~:!::I',,,'EL E:E"Fb~EEN THE OUTFF!LII_ [:'IF:'[::: I:::IND 'l-FIE: E:L')TTOh'I O1::' TI:tE E',:..':C:Ft'v'I::IT I ON < Z N FEET >. II':'E':F~:H:[T I:;IF'F'L.]:CFIN'I:' HFI'i"i; TI:iE I~.E.:,F_I',I:,IE, 1L:[ [~ -i:'O INI-:'L';IRH "FI:.iZZ E)EF:'FtRTHEI'.,FF E:,l_ll;:l.I['..!,12i THE · ,.::-::, ::'-. - , ,::' :" c: It-II-, F I:. _FEIE I r l:::li".lE) THE; '-[NE;TF:iLI._I:::IT];CU",I :[IILI: I:'_. _. I: Z .. I ,L Ell:: I:l[",l"r' I.IE. II.J _.,E.F.E. !Ji'!E, EI. OF: F:EE;];E:,E:I"~CE'.:~; THF:!T THE II,.IEL.II_ II4'[L.L ':' '-",'"' P'IZN:IIHUH E)Z';":TFI::INC:E BETIIqE:EN f:l I,.tEL.L. FliqD RN'.? Otq-E;ZTE 'Z.;EP~RGE DI'SPOSF:IL %Y"_-:'I"E:H Z:.'.:; :I_OEi I::EET F'Ol:.~: F:! PR :E VI::FT'E P.IELL.~ ::L'.:50 TCI 2(~IZ'~ FEE-I:' FI:::'.OH F:l PLIE=L:[O 14ELL [>EPEi'.,tD:[II.,!i.Ti LJI::'I.'.)N THE 'T'~T'F'E OF' F:'UE~L. ]: C: .L,.!ELI ..... I,.FFELL. L. OGE; FIF'.E F4:E);HJ]:I:;~:IEI)FIND I"I:UZT DE RETUFE'.NE[) -FL') TI:iE DEF'FFFF.':THENT F.I:[THZN :~:E~ DFf"r':5 OF' THE I:4EL. L. COFtPLEI"ION. OTFIEI:;'. F;'.EE:!U'_r. IRI::E. HENT'.:5 f'II::I'T' I::tI::'PLV. ~;F'EEL-:]:F!CFY'I:'!ON::_i t::IN[:, E:L')NZTI~:UE:TZON DZI:IGF~'.FI["IE; FIRE FI?'FIZLI::IE',II_IIE TO ]:N'.'E;LIF-?.E F'RL3F:'EI:;:'. Z['.,t:E;'I"I::ILL. FIT_TCI[q. I CEI::::]" ]: FV :L: I FIH FFIIP'IZLIRR II,.I]:TH THE: I:.:..'EL::!UIREHEIqTZ I::OIE: II:~i'.,!-.E;l:'l"E 2;EI.,.IER2; RNI) 1.4EL.L'_.'.'~ FIE; SET/' FOI:;UI:'H B'-r' 'THE HUN:[C::[F'F:IL.]:T'-r' OF' 2: ]: I.,.IZL~[... INSTI::II....L THE '::_:;'T'ZTP_-H IN I::IL-:CF~RDF:tNC:E II4ITH THE E:CIDEL:;,. .Ei:: !' IJNDEI:.;:':'II';TFIND 'THFIT THE: ON--ZITEE E;EF.IEF: ':E;'¢%TEf,t f"IFCT' I:'?E~;)U_I:F:fE F2NLFIII:;:GEHENT 'ZF THE '. .,%. -.. · GRL ER ANCIIORAGE AREA BOROUg "' DEPARTI4ENT OF ENVfRONMFUTAL Qt:ALITY ~..- 3330 "C" Street -: ' .ANCHORAGE. ALASKA 99503' Case Reading Date Gross Time Net Time I)ep~.~_.l~...Ul~,~.~..t Drop , I . ( . .i i ,~~~ Percolation Rate Mi nu ~.e Proposed Installation: Seepage Pit 2<. Drain Field Depth of Inlet . ~ Depth to Bottom of Pit or Trench COMMENTS: L~J~_.c.o~4~v~ -~r~?% ?~ ~ ~,~ ~~ '~ ~"~ ~ iI g- lO- 11-- 12-- 13-- 14~ Was 6-- d~ JZ7 . r~ .. 6round Wa,er Encountered? .1~ ..O.* I I J I 1 I l.l' i-f Yes. At What Depth? LegAl Description~'~Lot \ f,o- t9 S-~;';siom %1¢~/,/~,i¢, S.~. (&?'~). T~is Form Reports Soils Log ¢ : ~ercolatio~ Test - Soil Tes~ [.lust Be Logged To 4' Below Proposed Seepage System - - Depth " Feet Soil Characterist(cs I',g~ 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 ~',..~. Z"~ t~, GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name '~I¢-~P~.,~, I~.!~ Telephone: Home ~,&~, -~-'8¢.'7 Business Applicant Address ~ ~) I~'~,)~ ~ ~----~/1~}( .,J~,~ ~35G'7 (c) Applicant is (check one): Lending Institution []; Owner/W,:J~¢~ J~; Buyer []; Other ~ (explain); (d) Lending lnstitution -~:~=' ]'/~,~;~.,~E:C~J"~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the followin/g, address: TYPE OF RESIDENCE Single-Family I~ Multi-Family [] Other Number of Bedrooms WATER SUPPLY Individual Well [Z}' 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 ~ Public [] Com'munity [] 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 1 of 2 72.025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, D,...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 adeq cate 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 comptiance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~::,~.,vuc~.~ ~-'~?~-e¢,~'1~4. Telephone Address ~1 ~ ~ ~ ~n~a~ Date ~ I ~ DHEP APPROVAL Approved for '~"~.,) bedrooms by ~, ,% Disapproved Terms of Conditional Approval Conditional CAUTION The Mui~cipality 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 MUNICIPALITY OF ANCHORAQr- DEPT. Ol= HEALTH & ENVIRONMENTAL PROTECTION Legal Description: WELL DATA Well Classification I~'~IVAT~ If' A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ?/ Date Compietedj ~- /O --~' Yield Total Depth /¢z'/~ ' Cased to ~z'5 C~'~¢~'4~)epth of Grouting Static Water Level /'~ · Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 2,4" Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) JoI -~ ('-~4~hk ¢-~,.) ; On Adjoining Lots lOOt $ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot C.~","-'~'t~'~ ~-~,5:~ 1~ ; Date To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~-,' ~'~" ,( Ioo/F B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ICl [ To Property Line To Water Main/Service Line Course I.~1 ? Size I COO ~ No. of Compartments 7_. ~ Air-tight Caps (Y/N) ¥ Foundation Cleanout (Y/N) Date Last Pumped '3"~,~,~-. ~ ¢~ ; for Temporary Holding Tank Permit (Y/N) (~,...)'~ TO Building Foundation TO Disposal Field ~' (j~.~,,~4;:~ ¢.o) To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Ares Depression over Field (Y/N) Results of Last Adequacy Test Depth of Field I'Z~' Gravel Bed Thickness "7~¢~ '~-.~ $.,¢ (~.co-,,-4~,) Standpipes Present (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field Z~ro' ( rc_'~of'~::~ To Water-Supply Well To Building Foundation ,~',,~' Lot N ¢ To Water Main/Service Line joo¢ t- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments OY'~ ~')', =,1 1'~ ~'~*~1~.~o~ ¢.¢-~'~'¢¢ ~8'(::~1c~,¢ .'~ To Property Line '-,2~¢ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) 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~Ad'cess (Y/N) ,~ ~-~' "Pump Off" Level at · ~ ~ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ¢-~' Signed Co m pa. y ~-~.'~..~ Receipt No. Date of Payment Amou.t: $ . ** 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. Page 2 of 2 72-026 (11/84) l} APPLIr ' NT FILLS OUT UPPER H ONLY ~->r°p~r~wne~/~'~--~'~. ~, 4 ~-/~ ~, ~~ ~ Phone~ Buyer Address Zip Code Lending Institution /~ ~ ~ ~/~ ~/V~/~ Phone Address ~ ~ ~~ ZipCode ~/O~ Phone Realty Co. & A~nt Address Zip Code LegalDescription Z~- /7 ~/5'~ ~/~ ~C /~ ~/O~ Slreet Locati~ Type of Resi~nce ~ Single Family ' ~ Multiple Family No. of Bedroom_ ~ ~ Other Water Supply IndJv~dual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if svailable). ~ Pubric Utility Sewer Disposal /~0 ~ Individual Year Individual installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time (~/ ~ Date Date Date Date Inspector Inspector Inspector inspector Field Notes: ~UNIC]PALI~ O~ ANCHORAGE /~ ~ ~ DFPT ~ ENVIR:ONM~N ;A. ( ) CONDITIONAL APPROVAL* DATE ~ ~ ~ / ~ ~/~2 WelltoTanA //~ Septic T~k Size 72.023 (31~) January 31, 1983 Dale D. and Pamela C. K.~.soee SR~Itl BOX 3468 Klondike Chug iak, AK 99567 Subject: Lot 17 T15~ R1W Sec 19 ~IOA Approval for tn,, individual ~.,ewer and ~.~ater facilities cannot be g~anted until the follo~ing iteras have been completed: o A ~.~e].l log submitted to this office fo~ ou~ files review. The water analysis report needs to be submitted to this offlc- from the Chem Lab, 5633 B Street, for our review. The septic tank pumped with a receipt submitted to this Expose the ~,~e].l for our /~ construction, also to insure ~inimum distance requirements are met between the ~e3_l and sewer system. Please notify this Department for a reinspection when the noted discregancies have been corrected. If there are any further questions, please call this office at 264~4720. Sincerely, Jim Roberts . ' · ' Specia!i~t Associate Environmental JRS0/p/EH , / MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI(~IVIP'ONMEHTAL pROTECTiON 82ELStreet-Anchorage, Alaska 09,01 APR 1981 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. PJease allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) PHONE MAILIN~ ADDRESS ~ 4. REA~/AGENT / ,~ / / ~ ~ PHONE 5. LEGAL DESCRIPTION ,,Z,,-/-/7/7 STREET LOCATION 6. TYP~/OF RES DENCE NUMBER OF BEDROOMS [] One [] Four , [] Other ,~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM /~ INDIVIDUAL/ON-SITE** **If individual/on'site, give installation date If system is over two (2) years Did an adequacy test is required ~] PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TiME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL ~] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED [~] PUBLIC UTILITY Connection Verified iNSTALLER [~]Septic Tank or ~]Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER 'I'OTA L ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~ APPROVED FOR ~"~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) 72-010 (Rev, 3/78} 825 "L" STR[~ET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SU££1VAN, MA YOR DEPARTMENT OF HEALTI-I AN[) ENVIRONMENTAL PF~OTECTION April 16, ].981 Ralph Moody Box 140 Klondike Street Eagle River, Alaska 99577 Subject: T15N R1W Section 19 Lot 17 The sewer system on the subject property was installed but not inspected by this department. An engineer was contracted to do the installation inspection. The problem arises with two(2) inspection forms~ both with the same legal, both no__t stamped by an engineer. In comparing both reports, they are contradictive to one another. Therefore, prier to approval the following will need to be completed: (1) Expose the septic tank manhole to verify its/ existance. (2) The septic tank pumped with a receipt submitted to this office° The total number of gallons pumped /~' need to be on.th~ receipt.and verified by a registered engineer. T hzs is to verify the s zze of the tank. An adequacy test needs to be performed on the existing leaching area. This test will determine if the systera is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department for our~[[ review. · Ralph M~ody April 16, 1981 Page Two (4) A four(4) inch cast iron cleanout needs to be installed to the septic tank. This will need to be reinspected by this department. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Red Carpet Greatland Realty Post office Box 633 99577 Peoples Bank and Trust PQuch '7-007 99510 825 "L" SI'REET ANCHORAGE, ALASI/~A 99501 (907) 264-'1111 GEORGE M. SULLIVAN, MAYOR OL:PARTMENT OF HEALTH AN[) ENVIRONMENTAL PROTECTION April 8, 1981 Ralph Moody Box 11.40 Klondike Street Eagle River, Alaska 9557 Subject: T15N R1W Section 19 Lot 17 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The water analysis report needs to be derive_ed to this office from the Chem Lab, 5633 B Street, for our review. A four(4) inch cast to the septic tank. by this office. iron cleanout needs to be installed This will need to be reinspected (3) The septic tank pumped with a receipt submitted to this office. (4) The engineering report we have on file is not dated, stamped or signed by the engineer who performed the inspection. This will need to be completed prior to approval. If there are any further questions~ please call this office at 264-4720. SincerelY, Robert C. Pratt, R.S Associate Specialist RCP/ljw Realty cc: Peoples Bank and Trust Red Carpet Greatland Pouch 7.-007 99510 Box 633 99577