HomeMy WebLinkAboutMAJESTIC VALLEY ESTATES BLK 3 LT 6
GRE ,ER ANCHORAGE AREA BOk,.LIGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
'L
FROM WELL MANUFACTURER v MATERIAL ~ COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT ¢....2 GALLONS.
-~IL-E DRAIN FIELD:
J r f TOTAL LENGTH . I
DISTANCE FROM WELL t00'"~FOUNDATION .~O'"'~- _NEAREST LOT LINE /O ~ OF LINES
NUMBER OF LINES DISTANCE BETWEEN LINES l 0 TRENCH WIDTI-I ~ TOTAL EFFECTIVE
ABBORPTION AREA ~ ~ 1% 5Q. FT. LENGTH OF EACH LINE ~J 5~ ~ ~¢J ~ ¢O
/ II DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE ~
MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:
BUILDING ,)1 NEAREST I
FOUNDATION S LOT LINE /(''-~ ,gL NEAREST
, SEWER LINE~L%~,
CESSPOOL OTHER SOURCES
__ DEPTH DISTANCE FROM:
f
SEPTIC //~) ~4L. SEEPAGE [(..~C..) ~
TANK /"-"~ .~ SYST E M
APPROVED DISAPPROVED REMARKS
DISTANCES: / DIAGRAM OF' SYSTEM
SEWER LINE DEPTH:
LOT SLOPE: _ ~k~
R,--MA RKS: ~ __~'~__
~ G.A.A.B.
PERMIT NO.
[:,EF'RRTHENT ~'~ FIEFIL..TH FIND ENViRI]NhiEI",Ft'F~I- ':'IE'.O"t
825 STREET., I~NCHORFIGE, ElK.
( 77102 )
Ft P P L I C FIN T
I_OCAT I CIN
L~EGAL
GA F..'Y F'OGI::INY E: O ;:'~',
L6 Bi: MRJ'ESTIC Yf:I[.J._EY
TYPE OF SOIL FIDSORE~'I~IOI'.,I SYSTEM IS: TREI'.,ICH
I',I[:~HIHIJM NUI"IBER OF BEDRCIOHS = 3
SOIL. RF:ITING ,{S6! E'T,.."E:R)= :LT'::I.
..,I,~.E OF 'THE SO. IL. FIE'gCF.'F'"FII"~N .:,~r-~lE. fl .[::,.
THE REg!UIRE[:, ':' -" .. - "-'"' ........ "~
:ii!;CSJF/RE F'EIL{ I"
THE LENG'I-'H DIMENg:ION IS ']-HE I...ENGTH ,::IN FEET) OF' 'THE TRENCH OR DRF:IINFII:::i..[:,.
THE DEPTH OF FI TF. tEt"ICH OF4'. P I T I'.F., THE D I STFfl'.~E:E BETI.,.IEF:i:I'q THE SURFFICE: OF 'THE:
GF.'.OUI'.ID FIN[:) THE: BF.)TTOI"I OF' THE: I~XCFIVI::iTION ,:::171'.,1 FLEET).
THERE I'.---; NO SET I.,IIE:,TH FOR TRENCHES.
THE 1'3RFI',,,'EL. DEPTH IS THE I','IINIHUH [:,E'PTH OF;' GI:;?.FtYEI.. E:Ei]"!.4EEN 'I"I-[I:~E OI.J'I"I::'FII._I... PIPE
[:tN[:.', THE BOTTOr,1 OF THE E',:<C:FI',,,'~a"r.T. ON < ~N F'EET).
H INiMUM D ISTflNCE BETWEEN R I,.IELI... FIND ANY ON-SITE SEI4FtGE D ISPOSt::il,. S'.,.':..i!;'T'EiI"I
M:H:} FEET FOR. R PRI',,,'RTE I.,JELL OR 200 FEE]' FOR R I::'UBLI(3 WELl ....
WELL LOGS faRE RELT.!UIRED FiND f'IUST BE F.'.ETIJRNED TO THE I')EPARTHENT 1.4ITHIN 30 DRY'E;
OF TI4E HELL COMPLETION
SPEC IF::ICA'T'ION2; FIND CciNSTRLIC"FIf.]N D]iF:tGRRMS FIRE RVRI L. FIE}I....E TO INSURE E'ROPER
I N S"f'SLL. FI'T' I CIN.
I CERTIFY THRT
i: i FIH FRMIL. IRR HITH THE RIEggJIREMENT:~.; POR ON-.SITE SEHE];.'.S I:':flq[:, t,.IEL.[..S FEi; SET
FORTH BY TFIE MUNIC]:F'RL ):TY OF RNCHOF.'.RGE.
2: I WILL INSTFtLL THE 5'¢?,TEH IN RCCOF.'.[:,RNCE P.IITH THE CODES.
.3:: ]: UNDERSTlaND THFtT THE ON-SITE SEt,.tER SY%]'EM I'IRY F.'.EC!IJ .I RE ENLRR. GEMENT IE' '['HE:
RESIf}ENCE IS REM0[:,ELEP TO INCLU[:,E MORE THRN 3 E:E[:,ROOM.'5.
08-E
Russell Oyster
694-2774
Soils Ef Foundations
Performed for:
GEO''CHNICAL 6' DEVEL
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Name:
Natltng Address:
Legal Description:
Depth (feet)
0
2~
10~
Ground Water Encountered: Yes
Proposed Installation: Seepage Ptt~
Comments:
SOIL LOG
?MENT CO.
Tel. No,
Earl Ellis
688-2280
Land Development
Soil Characteristic%
No
Drain Field~
Performed by: Date:
Fio~
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
~)~/,~') - q,~.~\ - ~ HAA# L~I ¢C'~ ~ f~f -%'-'~ ~
1, GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 6; Block 3; Majestic Valley Estates
Location (address or directions)
NHN Spruce Lane
(b) Property owner Graham L. Alvord Telephone: (home)
Mailing Address 1688 Ea.qle River Road~ Ea.qle Rive% A~..
(c) Lending Institution Telephone
694-7994 .Business
99577
Mailing Address
(d) Real Estate Company and Agent RE/MAX OF EAGLE RIVER ATTN: Raq Heb~.rer
Address 16600 C¢~erfield Drive, Suite 201, Eagle River, Ak. 99577
Telephone
694-4200
(e) Mail the HAA to the following address: (or check here,~ if hold for pick up.)
List contact person and day phone number below:
17034 Eagle River Loop Road No. 204
2. TYPE OF RESIDENCE
Single-Family eX. Number of bedrooms
3. WATER SUPPLY
Individual Well E~x 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 ~x 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.
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,
functionaland 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
Address
Date
$ & S ENGINEERING
n~n34 F. ag[e Ri-ver Loop Road No. 204
Telephone
6, DHHS APPROVAL
Approved for *y-
Approved
bedrooms by ¢ ~'~"~ ~'~c" ~
Disapproved Conditional
Terms of Conditional Approval
Date
The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph S 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 DHHSdonotconductinspections
or analyze data before a certificate is issued. The MunicipalityofAnchorageisnot responsible for errors or omissions
in the professional engineer's work.
A. WELL DATA
Well Classification
Well Log Present (Y/N)
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: /---o]t- ~ ')
Date completed
O'' d
Total Depth--2,~ Case to,~-~, :~l~)epth of Grouting
Static Water Level _ ,~-
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot _ [ (20 '/'
To Nearest Edge of Absorption Field on Lot
&loc_-/( )
Pump Set At LJ l'~"
Sanitary Seal on Casing (Y/N) ~ ~
Depression Around Wellhead (Y/N) t0
If A, B, C, D.E.C. Approved (Y/N)
Yield
; On Adjoining Lots
[ CO f ; On Adjoining Lots
To Nearest Public Sewer Line ^~/A To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot 2 ~ /'/'
Water Sample Collected by ~~'~'IL % ~"~j?;tO~'.E'I~J.~ ;Date (o- I ~--~'~
Water Sample Test Results - ~f~/'~ '-~¢~C_..%F'c( ~ /~Ac.'TL"c~¢/'Pw
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed "'~r-/~- ~-'~ Size
Standpipes (Y/N) _ L~
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) td/~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well _
To Property Line
To Water Main/Service Line
l Ooo No. of Compartments
Air-tight Caps (Y/N) h Foundation Cleanout (Y/N)
/O Date Last Pumped (.¢ - ~ (¢ - ~ Dz.'
A2 //,'~ ;for /,k.) ///:t
Temporary Holding Tank Permit (Y/N)
Building Foundation
To Disposal Field
To Stream, Pond, Lake or Major Drainage Course /",-)/~
Comments .~) r= iJ'/3 TI'C.
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata _
Date Installed _ 7- /,2~__ '"¢ ~Z
Width of Field / _~ '
Square Feet of Absortion Area
Depression over Field (Y/N) _
¢/~t::~' Type of System Design_
Length of Field ~'-~-~
Depth of Field
Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well / Oo / ~-
To Building Foundation ~0 ~
Lot ~///~
TO Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course ..
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line.
To Existing or Abandoned System on
; On Adjoining Lots 20/'/'
/O"P
TO Cutback (if present)
[0o /'¢-
D. LIFT STATION
Date installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
_ Vent (Y/N)
Pumping Cycles during Adequacy Test.
**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 th'iS
inspection.
Signed S .& S EfqGINEERiNG
Company _ 17034 E~gle Eivm' Loop E(~ad No. 2~4
~agle River~ AI~A~ ~;~7~
Date ~[/~ /~V
OA o. ¢¢ ¢
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL
DEP¥-X~rMEb[~ OF HEALI~ ~D E~VII~ONMENTAL PR(IUECTION
APPLIC~:rION FOR HEALTH AUTHORITY APPROVAL CE!~EIFICATE
~ Information Application Date
1 Gmneu al
(a) Legal D~scription (include lot, b].ock~w~s~ubdivision, sg,~tion, township, range)
Locz~tion (ad,l~ess o~' directions)
(c) Applicant is (check one.) lending Institution C[[~; Owner/lk~ilct~'r ~;
Buyer ~..--~ ; Other [---~-_[ (explain);
(d) ]lending Institution lel~phor~
Address
(e)
P~al Estate Co. & Agent_f~z_'~' " _ ''
Address ~ ~ i C~
T~. of Fesidence
S i ngle-Famil.y ,~
Number of P~edrccr~
Multi-Family
Other (describe)
3. Wate~
Individual Well ~. Cx~mmun.ity t--I tklblic ~
Note: tf crm~',unity v~ll system, must have ~itten confimration frcm the State
Department of Environ,~ntal Ccnseruation attesting to the legality and status.
-Is the ~1]. adequate for the number of bedrccm~s slYecified in this
4. ~ewg~Jg_ D_j sposa!.
Onsite .~_ Public [__--~ Co~unity t---~-- - Holding TapJ~ I~
is the wastewater disposal system adequate for the rl~nbsr of l~droc~s
[Paue 1 cf 2]
2-15-84
5, ~__,n~gjneering_Firm Providi__n~_~c.__tions, 2b. sts, !Data and Information
I certify that I ~a~c~c-~e~cked, verified, or cx~nforme, d to all MOA tiaa C~aide!ines in
S igned_~~~ .... Date
Na]re of F~i~.,/ Telephone
Adclvess
Date
(ENGINEER SEAL)
6, DHEP Approval
..Approved for
bedrooms
Disapproved ~
Conditional
Te~s of Conditional Approval
The Municipality cf! Anchorage Department of Health and Environmental F£otection dces
not guarantee the continued satisfactory performance of the water supply and/or the
was'tewate~ disposal system. 'Enis approval indicates that, as of tt~ validation date
shcx,rn above, [k~_,d on the data and information furnished by an e~..]ine, er ~'e..n. ist~re.d in
the State of Alaska, the water supply and wastewater disposal system is saDi.~ and fun<>.
tional for the uamber of kedrcoms and type. of structure indicated,
( DflEP SEAL)
7°. Mail the HAA to the following addcess:
KB2/d5/s
[Page 2 of 2]
2-15.-8~.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classificatlo~ ~)/~-
Well Log P~esent. (~
Total Depth ~ GO Cased to
If A, B, o~ C, D.E.C~ Approved(Y/N)
7 '-~ . ' Yield ....
Date Completed ~/) ~, ~~~'
?
~ ~ O Depth of Grouting.
Static Water Level ~ ~ ~ ! Pump Set At
Casing Height Above Ground /~-- j~ 7~-
Electrical Wiring in Conduit ~
Separation Distances from Well:
Sanit.~uy Seal on Casing~
Depression ArOund Wellhead ~ _
To Septic/~m~3-Tank ~n Lot /~)~ 7/-, ; On Adjoining Lots
TO Nearest Public Se~ Line /~ To Nearest Public Sewe~
Cleanout/Mar~ole /O //~ To N~,are. st Sewer Service Line on Lot
Water Sample Collected By.~'!~'%/~//~'~'z/~J Date
Water Sample Test P~sults c~ 7~J~-/g~/~/~/
Comments
Be
SEPTIC/HOLDING TANK DATA
7// Cc/~pa~ tme nts ~
Date Instal~ ~/~ Size /~)~ No. of Cleanod~)
Standpipes (~/N) - Air-tight Caps,) Foundation
Depression' ove~ Tank (Y~ Date Last p~.mped _ ~/~/~
Pumping/Maintenance Contract q~ File (Y,/N)~/~4 .; for - -
Holding Tank High-Water Alarm (Y/N)/Q//~ ~ TemporarY Holding Tank Permit .(Y/N)
Separation Distances f~om Septic/Holding Tank: ~
To Water-Supply Well /~ ~
To P~operty Line /~3 ~
Main/Servic~ L.ine ~///~
To Water $~/~ _
Course
Comments
To Building Foundatio~_~ .... ~' °~
To Disposal Field / ~ / '~
To Stream, Pond, I~ke, or Major Drainage
[Page 1 of 2] 2-15-84
Co
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
~ Type of System Design
Length of Field ~i~/'
Depth of Field 6 (
Gravel Bed Thickness
· Square Feet of Absorption/~ea ~-/3 Standpipes Present
Depression over. Field (.Y~ Date of Last Adequacy Test
Results of Last Adequacy Test. ~/~
Separation Distance f~om Absc~ption Field:
To te -Su ly ¥' To operty /O
To Building ~ugdation ~-~'~ ~ 7& To Existing or Abandoned System cn
Lot / //~L ; On A~joining Lots ~C~ ( ~/
To Water Main/Service Line /~///~ To Cutbank(if present)
To Stream/Pond/Lake/c~ Majo~ Drainage Course ~//~
To D~iveway, Parking A~ea, or Vehicle Stc~age A~ea .~(~d~' ~ .7~
Con, rents
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
· ~anh~le/Access (y/N)
~'~ Off" Level at
' //~/~ Vent (Y/N)'
~ets MOA
cor~ents
** Check Permitted Bed~ocm Rating Against HAA Request **
I certify that I have checked, verified, o~ conformed to all MOA
on the date of this inspection.
Signed ~ ~ ;~ ~ ~,,~m,~,~,,,~ ·
KB1/d5/s
[Page 2 of 2]
2-15-84
Jim Sullivan
688.2510
COMPLETE WATER SYSTEMS SALES & SERVICE
& WELL
NWWA CERTIFIED PUMP INSTALLER
280
WELL RECOVERY TEST
Alaska
Distributor
P.O. Box 197
Eagle River. Alaska
WORK ORDERED BY:
ADDRESS:
LEOAL:
t
DATE:
CASING DIAMETER
CHECKED (.~.__
VERBAL( )
WELL LOG ( ) ...~,~ //
PUMP SET
CHECKED ( )
VERBAL( )
WELL LOG ( )
DRAW DOWN
CHECKED ( }
VERBAL( )
WELL LOG ( )
COMMENTS:
TAKEN BY:
DEPTH OF WELL
CHECKED()
VERBAL()
WELLLOG()
STATIC LEVEL
CHECKED(}
VERBAL(}
WELLLOG()
RECOVERY RATE
CHECKED(}
VERBAL()
WELLLOG()
COMPLETED BY:
TANK CAPACITY
CHECKED( )
VERBAL ( )
WELL LOG ( )
PUMP HP
.CHECKED()
VERBAL()
WELLLOG()
SCREENED(}
OPEN(}
PERFORATED(}
LINED(}
#1: Time
DEPARTMEN
825
Insp [ ,{ ..)z//, ~'
MUNICIPALITY OF ANCHORAGE ~Q~-~
}F HEALTH AND ENVIRONMENT, PROTECTION
L Street, Anchorage, Alaska 99501
279~-2511, ext. 224 or 225
Date Received:
#2: Time
Date
Insp
June 28.t 1977
#3: Time
Date
Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request:
Mailing Address:
Phc)ne:
2. Property Owner: Charles/Pogany Development Phone: 688-2390
Mailing Address: Box 323 99577
3. Legal Description: Lot 6 Block 3 Majestic Valley Subdivision
4:
Single Family Residence: (
Multiple Family Residence:
Number of Bedrooms: three
Number of Bedrooms:
Well System: Individual Well (~ Community/Public System ( )
Permit # 77102 Depth of Well Well Log on File ({)
Construction Bacterial Analysis
Sewage Disposal System:
Permit It 77102
Septic Tank Size
Absorption Area
On-site System ~ Public Utility ( )
Installed 1977 Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic ].an].
to Sewer Line Nearest Lot llrle
to Nearest Lot Line
to Absorption Area
Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of [ndividual Sewer and Water Facilities
Legal Description: Lot 6 Block 3 Majestic ValleZ Subdiw[sion
Conunents:
Affadavit Attached.: ( )
Letter Attached:
Approved: ~~.
Disapproved:
Date:
Date:
Department Worksheet:
J',,~J ,I,.I ALh
.4UNICIPALITY OF: ANCHORAGE
Departmen~ of Healbh and EnvironmenCal Protection
[[t~ 825 L Street, Anchorage, Alaska 99501
~~ 279-2511, ext. 22~, 225
~Request for Approval of Individual Sewer and Water
1. Property Owner:
Mailing Address:
2. Name of Buyer:
Mailing Address:
Phone:
e
Lending Institution:
Mailing Address:
Realtor/Agent: GIO~
Mailing Address:
Legal Description
Street Location: ___~_~
Phone:
Phone:
e
Single Family Residence: (~fk.. Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
o
Water Supply: * Individual Well ~)
If Individual Well., we].l depth
If Couununity System, name of system
Public/Community System ( )
Sewage Disposal System: On-site System (y~ Public System ( )
If On-site System, date of installation:
*NOTE: A well log is required on ALI, wells drilled since 6/75.
3/77