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Home My WebLink AboutMAJESTIC VALLEY ESTATES BLK 4 LT 8! 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 IPFIONE 1 [~NEW MAILINGADORESS LEGAL DESCRIPTION LOCATION N~ OF BEDROOMS Well Absorption area --_~ ~, Dwelling DISTANCE TO: /~ ~ / _//~/E~ F- Z Manufacturer Material No. of compartments Liq. capacity/~¢in gallons IF HOMEMADE: Inside length Width _ Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~; DISTANCE TO: Well //~, I:ounOatio~o, Nearest lot line, _~ Length of each line Total length of lines Trench width Distance between lines ~ ~ Top of tile to finish grad~ Material beneath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller ~istance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE OTHER .... PIPE MATERIALS SOIL TEST RATING ~ ~ INSTALLER ~ APPROVED ~ / DATE LEGAL 72-013 (Rev. 3/78) '1 H!:: I..EI",t[;:iTH [::,]; t"'iE?,,l!:!; :[ O1",! ]: :!i; Ti,Il:i!; I'HI:':; [;,I!i;F'TI.I OI::~ f:i TI';;'.[:::NC:H Of;i: I-:':1;-!' GI:;;:OI..II'.,H;:, I::ff',ff::, TI..!F; [:!',()"l"i"Eff"l OF:' THF: 'il..IE:I:;;:I!.; :( :5 HO :!:!;ET 1.,.I ;( D'ITI ;::'OR 'TI..ll:!i; G1:;i:!'::¢,,,'i:i3. [;:,;:!;F'I-H ;!; i!:i; 'f'l..l~i; H ]: I::!!'.t[;:, Till'!!: I~!',EI"["I'EWI OF:' THE I:~:;:.::(::f::¢,,,'F~T DEPn~Tr'IEt'.,I~ OF HEflLTH FIND ENVIRO1',~r,IE1'.~Th. PROTECTIL]N . '"~ ~ ~ . 825~ /L" STREET, FINCHORFtGE., 264-472C4 PERMIT NO. ( LOCFtT 101'4 T'CPE OF SOIL I-3BSORBTION S"r'STEM 1~"~':/~ i'IFI,'4IMUM NUMBER OF BEDROOMS = THE REQUIRED SIZE OF THE: SOIL RB$ORPTIONq'_-~=,TEi]"- ' IS:, [:'EF'TH= ~ L E'I"4 f-~ T H = THE LENGTH DIMEN$IL'~N IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFI]:NFIEED. THE DEPTH OF Ft TRENCH, OR PIT IS THE DISTFINE:E BETHEEN THE SUF.:FRC:E OF THE 6ROUND R1"`ID THE BOTTOM, OF THE E;4CFIVFtTIF~N '.'.IN FEET). THERE IS NO SET WIDTH, FOR TRENCHE~. THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFI',,,'EL BETHEEN THE OUTFRLL PZF'E RND THE BOTTOM OF THE: EXCFIVRTION (IN FEET..'). C: TRI"',iF::: '--.-% I ZE= /1:~0 13F~LLC~I'-,I"5 R El;! LI T ~". EE Ii:" SEF"T I PERMIT 8F'PLIL-:I~NT HRS THE EE_,FLN_-,IBILIT'~' c '] '- TO INFF~Rr,1 THIS DEPFIRTMENT [:,URING THE INSTFILLFITION INSPECTIONS OF Fff.`lY HELLS FID..TflF:ENT TO THIS- FR_FERT.¢' Fi' ' F-IND THE NI_IMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI.-.II] ( 2 ) 'I r-,i'_=;PEC T I or-d_~, R-IRE F-:EC,..!I_I I F-:EC, BBCKFILLING OF FIi".,l"r' SYSTEM WITHOUT FINFtL INSF'EIZ:TION RND RF'PROVRL B'¢ THIS DEPFtRTMEi'-,IT HILl' BE SUBJECT TO PROSECUTION. MINIMUM DISTflNCE BETWEEN R WELL fiND tiNY ON-SITE SEWRGE DISPOSRL S'¢STEM I'-1 ~00 FEET FOR R PRIVRTE WELL; OR ~50 TO 200 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYF'E OF PUBLIC WELL. HELL LOGS RRE REQUIRED RNC, MUST BE RETURNED TO THE DEPRRTMENT WITHIN }E~ DRYS OF THE HELL COMF'LETION. OTHER RELqUIREMENTS MR9 RF'F'L¥. SF'ECIFICRTIONS Bf.4D C01'.~STRL;E:TION DIRGRRMS RRE 8'¢RILRBLE TO INSURE PROPER. INSTRLLRTION. F'ERt'I I T E ~---~ P I F4ES [:,FE:EhlE:EE: -----::1.. :.t'~-* 7'_=,- I CERT I F'.r' THI3T 1: I Ffl'l FRMILIFIR HITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH B'¢ THE MUNICIPFILIT¥ OF RNCHORFIGE 2: I HILL INSTRLL THE SYSTEM IN RCCORDFINCE HITH THE CODES. "<: I UNDERSTF~I".4D TFtFtT THE ON-SITE SEWER SYSTEM MR¥ RE~UIRE ENLRRGEhlENT IF THE RE'_qIDENCE IS REMODELED TO I1",ICLUDE MORE THFIN 8 BEDROOMS. :5 1 GNED' / ~ Russell Oyster 694-2774 Soils Et Foundations EGEOTL.;HNICAL ~t- DEVELO. MENT Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG CO. Earl Ellis 688-22.80 Land Development Performed for: Name: Mailing Address: Legal Description:. ._: :: .... o Tel. Nee ~ ~4 ~5 16 Ground Water Encountered: Proposed Installation: Comments: No Seepage Drain Field .... Performed by: Date: <~ Q 0 ]~UNICIPALITY OF ANCHORAGE DEPT. OF I~M, LTH & MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVIOES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ~%("3 - '").'~ ~ .~j._~ 1. GENERAL INFORMATION Complete legal description Lot 8; Block 4; Majestic Valley Estates Subdivision Location (site address or directions) NHN Imperial Drive RoY and Celia Anderson · 'P.O. Box 1331, Soldotna, Alaska Day phone 99669-1331 283-7962 Property owner Mailing address Lending agency CI~z MOR~AGE M a iii n g 'a d d res s'"'~: Anch0rage/ATTENTION: Day phone Netda Gilchrease Agent George Perkins/PERKINS REAL ESTATE Day phone Address 1719 Eaqle River Road, Eaqle River, Alaska 99577 Unless otherwise requested, HAA willbe held forpickup. NUMBER OF BEDROOMS: 3 ~ 694-3594 TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 s~uewwoo leUOp,!pp¥ :suo!~elnd!~,s 8U!MOIIOJ eqj q~!M 'SCUOOJpeq 'suJooJpeq Joj le^oJdde leUOp,!puoo 'pe^o~ddes!Q . ~oj pe^o~dd¥ ~ ~II:In.LVNOIS SHHQ '9 e~n~euB!s s,Jeeu!eu=l sseJppv ZZ!~66 e~selV '¢e^!~t ~l~=" I~0~ 'ON peo~ dool .m^l~ el~e~ t~;OZt euoqd 9NI~I~ttNIgN~t $ '8 $ LUJ!-I jo eLUeN · uop, oedsu! s!q~ jo e~,ep eq~ uo ~,oejje u! suoReln6eJ pue 'seoueu!pJo 'sepoo re, elS pue ledlo!unlAI lie q~,iM eoueildLUOO u! s! LUm, S~S lesods!p ~e~,eMm, set~ ~o/pue ,~lddns Jm, et~ m,!s-uo eq~ 'uo!~oedsu! pue uop, eDp, se^u!/,LU LUO~J pue selg eDeJoqouv jo ~l!led!o!unR uJoJj peu!e~qo uop, eLuJoju! eq~, uo peseq ~,eq~ ~J!Je^ ~eq~nj I 'u!e~eq pm,~o!pu! e~ n~on~,s jo ed~l pue SLUOO~peq JO ~eqLunu eq~ JoJ e~enbepe pue leUOp, ounj 'ejes s! LUe~S~S lesods!p ~e~t~e),se~ ~o/pue ,~lddns ~eleM m,!s-uo eq~ ~eq), st~oqs uop, eoJldde leAo~ddv ,~Moq~n¥ q~,leeH s!q~, jo uop, ee!~,seAu! /~u ~,eq~/liMe^ I 't~oleq ut~oqs e),ep uoReP!le^ eq), jo se pue o~,e~eq pex!jje lees ,~u ~q pe!j!Meo sV iJ=r=INIDN=1 A~ NOI.LO=IdSNI 40 J. Nii]I/'g:::I.LV.LS Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: k-~,-'¢.~ A. WELL DATA Well type '~qz-~C'/'~f'~ If A, B, or C, attach ADEC letter. Log present~N) Total depth ParcelI.D. ADEC water system number Date completed 'Ct'- ¢'~"~"~'~ Driller Cased to '"¢~~:~-~' Casing height Wires properly protected(CF)'N) "7' Sanitary seal ~-.?N) ~'t/ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot \ \ Public sewer main h~' )/%' Sewer service line "~-~ ~ WATER SAMPLE RESULTS: Coliform '~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA AT INSPECTION g.p.m. ; On adjacent lots_ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~ ~¢' Other bacteria Collected by: Date installed Tank size \ (--"~¢ Compartments -~* Foundation cleanout ¢i~'N) "'/ Depression (Y/~ ~ Alarm tested (Y/N) ~ ~[ - I 6¢~'~ '7..- Pumper ,~--~.1~ '"~'..Pr--~ 'E::'~ ~.~ ~ Cleanouts~-¥/N) ~ High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I To propertyline Surface water/drainage On adjacent lots Absorption field I ~ Foundation water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~ - \ - "~ ~ Length ~'~' ' Width Soil rating ~.'~::~'¢¢=f//~¢---- System type Gravel thickness (-~¢ - ~'~z'tb Totaldepth 2¢¢---¢"'~-'¢ Cleanouts presentd~CTN) Total absorption area Depression over field (Y/~CJ~ ,"-/ Results,~C~/fail) ~-~,/~-~ Peroxide treatment (past 12 months) 1~,/~i~ Date of adequacy test for ~ ¢r---~vJ' ~ If yes, give date bedrooms Well on lot To building foundation On adjacent lots "~ Surface water Curtain drain /'V/¢/~'~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots / ~ ~:::~ Propertyline To ~xisting or abandoned system on lot Cutbank A/'/'A'~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Engineer's Name Date t;~NGINEERING River Loop Road No, HAA Fee $ (~j~'/~ '~-~2" ¢"~'" Date of Payment / ('~ //(/' /~ ~- Receipt Number c~'b\ / ~Lo / L-i~i \ ~'~.... ;n tbe..d~te of this inspection. Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 l?034 Eagle River Loop Road Eagle River, Alaska i)95'/1 . ,,. '~ I~ELL FLO~'/IESI I)AIA SHEEI LOOAT ONOFWELL(LegalDescrlptlon)..~ ~ ~ ~ WELLDEPTH: ~ FT. CASING: l~ ~,~. FT. STATIC WATER LEVEL ~op of Casing): [ ~ FT. DATE: ROr~ERT A. SHAFEfl CIVIL ENGINEER 694 2919 CLOCK ELAPSED TIME SINCE DEPTH TO DRAWDOWNI PUMPINO TIME F'UMPING STARTED/. __ STOPPED, MIN. "WATER, FT. RECOVERY RATE, OPM REMARKS 5 10 15 20 35 40 50 55 90 120 [2 hours) t50 180(3 hours) 210 RECOVERY t 0 0 5 20 25 35 Comments: Subsequent Variations Can Occur. CHEMICAL & GEOLOGICAL lABORATORY A DIVi~qON OF COMM£fICIAL TE~?INCt & F..N(31~tEBI"tlNG CO. 56~3 ~ STREET ANCHOHAUE, ALASKA 99518 TELEPHONE [g07) 8~-~348 FAX: Coll~etK] DCT ? 92 OCT 7 An~ly~i~ £o~pllt,d : OC~ 9 92 1)3 ~ ~ P~t&mate~ ~.ult, [h~it. HBth~d Allo~tbl~ COMMERCIAL TESTING & ENGINEERING CO. A K DIV CHEMICAL & GEOLOGICAL LA BORATORY TEL[PHONE {gO7} 5{3,q B Street Drinking Water Analysis Report for Total Colifo['m Bacteria TO BE GOMPi FTFD BY WATER SUPPLIER PRIVATE WATER $YSTEM Mo, D~y Year ,1~ Roullne [] Check Sample (for with I~b ref. no._ ........................... F1 ~p~clel Purp~)~e [] Trebled Water SAMPLE No. LOCATJON READ INSTRUC'rlON~ BEFORE COLLECTING SAMPLE TNTC = Too Numerous To Count OB = Other Bacteria COMPLETED BY LABORATORY Analysis ~,how~ thi~ Wal9r SAMPLE to be: El Unsatisfai;ton/ Lq Sample too long In transit; sample ~houId not ~ over 30 hours old at examination ~OVl eamplo via 6pO~ul de~i~'a~ mail. Tim* ReC*Ivod ..~/, Lab Ref. No. Analyat BACTERIO~,OG, Ig'^I. WATE~ ANALYSI~B REOOFID .......... --'nc.n .... Coliform/100 mi Dulo CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 ANALYSIS RESULTS fo~ INVOICE ~ 58406 Chemlab Ref.~ 92.4984 Sample { 17 Matrix: WATER Client Sample ID : L8 B4 ~[AJESTIC VALLEY EST. S/D PWSID : UA Colleoted : SEP 14 92 Received : HEP 15 92 P~eserved with : AS REQUIRED Client Name :S & S ENGINEERING Client Aect :SNSENGP BPO! : RoqJ : Ordered By :R. SHAFER POt :NONE RECEIVED Analysis Complsted : HEP 16 92 Laboratory Supex~o; ~TEPHEN C. EDE Released By : ~j.~ Send Reports to: l)S & S ENGINEERING Parameter Results Untts Method Allowable Limits NITRATE-N ND(O.I) 9/1 EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY; RAY. Remaxks: I Tests Performed ' Sse Special Inst~uctions Above UA-Unavailable ND~ None Detected '* See Sample Rermrks Above NA- Not Analyzed LT-Less Than, OT-Greater Than ~SG-C~ Member o1 ,he SGS Group (Soc,~tO GOn~rale de Surveillance) COMMERCIAL TESTING & ENGINEERING CO. AK DIV CAL & GEOLOGICAL LABORATORY ~ TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518. Drinking ~Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER FI PUBLIC WATER SYSTEM I.D. # I llllll ~PRIVATE WATER SYSTEM Narr~ Mailing Address Phone No, S & S ENGINEERING E~e River, ~aska ~577 SAMPLE DATE: Slate Zip Code Mo. Day Year SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE No. LOCATION Time Collected t READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ,"~ Satisfactory [] Unsatisfactory [] Sam~)le 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. Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* BACTERIOLOGICAL WATFR ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSB (~ Coliform/100 mi Fecal Coliform Confirmation BGEI Final Membrane Filter Results TNTC = Too Numerous To Count OB = Other Bacteria ~SGB Member of the Dale Time: Coliform/100 mi a.m. p.m. PART ONE OF TWO REMAINDER TO FOLLOW ~' MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H~:,-,LTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'IEI[~JRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION JUl: ! 6 t979 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 processed. Please allow ten (10) days for processing. 1. P~,OPERTY OWNER z~"~J~" J PHONE ~AILING ADDRESS PROPERTY RESIDENT (If different ~m above) ' PHONE 2. BUYER PHONE MAILING ADDRESS 3', 'LENDING INSTITUTION PHON~ MAILING ADDRESS 4, "EALT~JAG ENT ~AILtNG ADD~E88 B. LEOAL DESChlP+ION ,-. z/' STREET COCATION - 6. TYPE OF AESID~E SINGLE FAMILY MULTIPLE FAMILY NUMBER OF BEDROOMS -~ One [] Four ~ Two [] Five ~ Three [] Six --] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WFLL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~] INDIVIDUAL/ON-SITE** If individual/on-site, g~ve ~nstalJahon date','~'~//'~" · . If system is over two (2) years old an adequacy~est is required [] PUBLIC UTILITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) .) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TiME TIME TIME DATE DATE DATE I NSP ECTO R 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 TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS E~r---APPROVEDFOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY LEGAL DESCRIPTION 72-010 (Rev. 3/78) ______ P.O. BOX 4-1276 46,49 BUSINESS PARK BLYD. ANCHORAGE, ALASKA99509 Drinking Water Analysis Report for Total Coliform Bacteria TELEPHONE (gO7) 2794O14 TO BE COMPLETED BY WATER SUPPLIER PUSL,C WAT?R SYSTEM: L I J I I J I ./~ (- ~ I.D. NO. Mallln ~.~,ddreas f ~ City ~.~7 State SAMPLE OATE: Mo. Day Year Zip Cede SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref, no, [] Special Purpose [] Treated Water L3 Untreated Water SAMPLE NO. LOCATION , I Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME / CITY Date Received Time Received Analytical Method: Fermentation Tube Membrane Filter L Lab Ref. No. Result* Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310(3-78) 06-1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Date Received Time Received __ p.m. Lab, No =resurnptlve 10mi 10mi 10mi lOml ]0mi [.0mi 0.1mi 24 Hours 48 Hours :onflrmatory 24 Hours ':~: 48 Hours EMB Broth 24 hours:. Multiple Tube Report: Membrane Filter= Direct Count Verification: LTB Broth 48 hours: :tOm1 Tubes Positive/Total 1Omi Port~ons