The URL can be used to link to this page

Home My WebLink AboutT15N R1W SEC 19 LT 46-'ri' MAILING ADDRESS ~ 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 LEGAL DESCRIPTION D,STANCETO: ±' Manufacturer DISTANCE TO: iF HOMEMADE: Inside length Well Dwelling DISTANCE TO: No. of lines ! / Well ,*~.~ [ ~ /'T u Length of eac? ~ F°u ndati°nz~.~ /~ Width Material i Tre~v~6th ~ inches ~J~ inches NO. OF BEDROOMS PE.M, O¢ No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Total effective ~bs6rption area/- PERMIT NO. Type of crib Crib diameter Well Building DISTANCE TO: DISTANCE TO: ewer line Total effective absorption area Nearest lot line race to lot line PERMIT NO, Septic tank Absorption area(s} OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS b , .. , DEPBRTMENT L HEBLTH 8ND EW~IRONMENTBL _TEC. TION ~/, ~ ~.~ · , ~, ' 825 ~L' STREET, RNCHORRGE., RE. 9950~ ~ ~' ',' PERMIT NO. ( 809127 ) ~ ~ -I ' ~ ' RPPLICRNT JRMES TRR~L~R >_41 BRUCE LN. 24~-6~8i LOCRTION E.R. L46 TiSNRiWSi9 LOT SIZE 54e88 SQURRE FEET .sO PTZuN SYSTEM IS: T NCH TYFE OF ~OIL ' - MR>:;IMUM NL;MBER OF BEDROOMS = 5 SOIL RRTING <~0 FT/BR>= ~i5 ~ ~, THE REQUIRED _I~E OF THE SOIL RBSORPTION SYSTEM I~: C, EPTH= 8 LE~'-4GTH= 72 GRA~/EL- DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND 8ND THE BOTTOM OF THE EXCBVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). REQIJ I RE[." SEPT I C TRNK S I:-'TE= 1588 ,_]RLLOI'qS PERMIT RPPLICRNT HRS THE RESPONSIBIL'ITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL' WILL SERVE. TI4,D ( 2 ) I [-~SPECT I L--I[-~S RRE REQU I RED, BBCKFILLING OF 8NY S~'STEM WITHOUT FINRL INSPECTION AND RPPROVRL BY THIS DEPBRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTBNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM B PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO 8 COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLBTION. I CERTIFY THRT 1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLIT'z' OF RNCHORRGE. 2: I WILL INSTBLL THE SYSTEM tN RCCORDRNCE WITH THE CODES. -?-: I UNDERSTRND THRT THE ON-SITE SEWER S'T'STEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 5 BEDROOMS. _.IGNE[:. ~..p~ ~ RNT JRMES V4. 0 C~, 9 m 10- 11 13- 14~ 15- 16- 18- 19- 20- COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'~ SOILS LOG - PERCOLATION TEST / SLdPE SITE PLAN '~ SOILS LOG [] PERCOLATION TEST 72-008 (7/76) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT MESSAGE DATE SIGNED REPLY LREDTFORMJ, 4S 472 SIGNED SEND PARTS I AND 3 WITH CARSON INTACT PART 3 WILL SE RETURNED WITH REPLY, DETACH AND FILE FOR FOLLOW-UP DATE C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. water system was completed on --7/--"' ~, /2 (date). The system is hereby granted interim approval to operate for 90 days following the completion Cate. BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system, is hereby granted final approval to operate. .~, ..:., ?Z: t . ' BY / TITLE DATE DISTRISUTION: 1. WHITE - ENGINEER (Complete SecUon'C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEEPJMUNI-BOROUGH (Complete Section 4. GOLDENROD - MUNI-BOROUGH (Complete Section A 180407 (Rev. 11183) m0 0 0 0 0 0 0 0 0 0 0 0 0 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Lega% Description (include loC, block, subdivision, section, township, range) Location (address or directions) ~ ' -- 3 -- / ,' (d) tending Institutioa _/ (e) Real Estate Co. & Agent Telephone Address Telephone Type off Residence Single-Family ~ ~the HAA to the following address: Number of Bedrooms Mu t i-Fami .Gt eseribe) 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 the legality and status° Sewage a~ Onsite~ Publico 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 1 of 2] En~] Firm Tests File Search Data and As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of' this Health Authority Approval shows that the water supply and/or wastewater disposal system is safe, functional and adequa~-e for the number of bedrooms and ~ype of structure indicated herein°- I further verify based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the ou-si~e water supply and/or wastewater disposal system is in compliance with all Municipal and State codes~ ordinances, and regulao =ions in effect om =he da6e of ~his inspection. Name of Firm ,9 a ~ ~...MI~,~ Telephone Address PH, 694-~J9 Terms of Conditional Approval ~ADTION TH~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORII"f APPROVAL CERTIFICATES BASED SOLELY UFON THE REPRESENT~ ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN .£~w. STATE OF ALASKA° T~U~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND T~d~IR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- M~NTS. 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° (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR 274-2533 Mr. Robert Shafer, P.E. S & S Engineering SRB 196X Eagle River, Alaska 99577 SUBJECT: Lot 46, Section 19, T15N, 8521-FA-154 & 8521-DA-137 RiW, Class "C" Well, Eagle.River Dear Mr. Shafer: In response to our meeting today addressing the letter I wrote to you ~ on the 5th of this month the storage requirement you proposed of 280 gallons will be sufficient on a low pressure storage system. Final approval is hereby given for the sewer and water systems. The Certificate to Operate is attached for the water system. Any future expansion of the subject project will require additional approval from this office. Sincerely, SWE/dd ENCLOSURE: '-Steve Eng, P. E~.~ Environmental Engineer HEMICAL &' zOLOGICAL LABORATORI~ OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I.D. NO. Mailing Address Phone No. SAMPLE DATE: Zip Code · Day Year SAMPLE TYPE: [] Check Sample (for routine sample with lab ref, no. [] Special Purpose [] Treated Water .JZt~Jntreated Water SAMPLE NO. 1 Time Collected LOCATION Collected By TO BE cOMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,J~Satisfactory / [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Time Received tt~ ¥~ Analytical Method: [] Fermentation Tube ~.Membrane Filter Lab Ref. No. Result" I FT-] J I FT-] Analyst \/ O6,1220 (b) Rev, 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Ver(flcatlon: LTB BGB. Final Membrane Filter Results , ~ Reported By / Date / Time: TNTC-- Too Numerous To Count Coilform/100ml Coilformll0Oml WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Well Classificatior)~ Log Presen (Y~,) Well Total Depth ~ ~) Cased to Static Water Level Casing Height Above Ground ./2~ / Electrical Wiring in Cond N)' Separation Distances from Well: MUNICIPA£1~ OF ANCHORAGE D~r. OF HEALTH & ENVIRONMENTAL PROTECTION APR 1 9 1985 -I EIVED If A, B, C, D/E.C. Approved~) Date Compl. etea ~'/~ Yield ~ Depth of Grouting ~ /'" Pump Set At ~ ~ Sanitary Seal on Casin~N) Depression Around Wellhead (Y~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot T0 Nearest Public Sewer Line CleanouVManhole Water Sample Co,lected-~ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~'~¢--~/u (~ Size /~ No. of Compartments ~ Standpip~s/~N) Air-tight Ca~'~'N) Foundation Cleano~ ) _. Depressio~ver Tank (Y~ - ~ ~ Date Last Pumped ~///~ Pumping/Maintenance Cont%acton File (Y/N) r~ ~/~ ;for ~'~, ) Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N): /J ~ Separation Distances from Septic~nk: TO Water-Supply Well / ~) [~' To Property Line /O /"~ To Water Main/Service Line ~'-/...3 d ..~ Course Comments - To Building Foundation TO Disposal Field ~.~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11184) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,~O // Square Feet of Absorption Area Depression over Field (Y ~..~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation 2 Lot /d (../- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design / Length of Field · Depth of Field 2¢ Gravel Bed Thickness Standpipes Present (Y~) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~--'~0 To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) rump Off" Level at _[~_.,/ ~/?/~ent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA an~ HAA guidelines in effect on the date of this inspection. Signed ~_ Date ~./~/// Company ~ '~' ~"~lD~r-:'.~ MOA "o -- Receipt No. .p~, 69~..~.?~ '¢~e~ ~ ~ of Amount: $ - Page 2 of 2 72-026 (11/84)