The URL can be used to link to this page

Home My WebLink AboutMOUNTAINSIDE VILLAGE BLK 3 LT 2 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 ADDRESS LEGAL DESCRIPTION f../'n:z, LOCATION Well · I DISTANCE TO: / I- Z I Manufacturer ~-- ILq capacty nga ons E E · [ooO F HOM MAD : ~, O Z~ DISTANCE TO: Well Q I Well _ ; ~-rI DISTANCE TO: ~ ,T 2~ [ No. of lines ...-t [ Length of each line - / - ' m Length Width ~ F- [ Type of crib Crib diameter ~ DISTANCE TO: Well ..~ IClass Depth ~: I Building foundation DISTANCE TO / IAbsorption area Inside length Dwelling Foundation /e~s' Total length of Ii Material beneath tile Depth Crib depth Building foundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED / DATE LEGAL PHONE /~NEW Material Width Material Nearest lot line Trench width '~"~/.ainches inches NO. OF BEDROOMS PERMIT ~Q~ O 0 "~/ No. of compartments Liquid depth PERMIT N O ,,.~.~ Liquid capacity in gallons PERMITNO'~'/O O-~ ) Distance between lines Total effective abso,rption area PERMIT NO. Total effective absorption area., _ MUNICIPALITY OF ANCN¢SpAGE Nearest lot line [)EP'[. OF HEALTH & Distance to lot line PERMIT NO, Septic tank Absorption~]l~e~!~ i !) '"' ' Box 1369, ST~l~ IIOUTE A ANCHORAGE, SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF ~.00 PER FOOT. ~ ~& PROPERTY OWNER ~ WELL LOG: 1/2 _~[IZ ,tokn, L. ~.e~_n~e,U~. ,~ ~em~. .a. aaa& al~ou, l~ ~~ Z. G ~,tor~ ~ ,I,t. ~. ,~,~u,,e. 0~. 350 Co.~ 0¢ ~~: tl~.oo ~ /,t x ~o ~,~: ;5750.00 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF -.------ ........ THANK YOU VERY MUCH. DATE BERNIE CLAUS OF RAMPART DRILLING WORKS ~ERVICE CHARGE OF 1y~% PER MONTH WILL BE ASSESSED ON'P,~ST DUE ACCOUNT~. C Oi",iT)::iC T L. EGI::IL.. i..Oi :5:I:ZE: HI:I::':: liiidi!!:L')I:;;'.O0t"l:!;: 4::-"~<:' :'"] !:::! (':~ !i;~:.,¢ I:Ii< ::ii: ,4. ,::l. '"" [2:.~ :i!;~ 6 d; , Village '~i!;I...li~ii:t:::, ]: ',,,' ]: '.~!; ;1: Ol'.,! ' "iOU' ,1"t"~" :[ hiE; :[ DiE L :~;EE:T I O['.,i: :~:5 T OHi'.,!~SH ;1: F':t2N R ~IN G E: :~:1,,,I 5E;EIEiEI ,.::E;(;;h I::'T. Ed:;;: ::~: DI::ITE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCmPT,ON: L o } ~., L~ i o ~ k 0£ 1 2 3 4 5 6 7 8 9-- 10 11 SLOPE DATE PERFORMED: SITE PLAN ' WAS GROUND WATER ENCOUNTERED? · IF YES ATWHAT ' , ~ DEPTH? 12 I 13 14 15 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop 1:~4 0.3'o PERCOLATION RATE ,~ ~ (minutes/inch) TEST RUN BETWEEN .~ k'~. FT AND 4 FT CERTIFIED~Y: DATE: i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST ! PERFORMED FOR: L.~A~ F~_,c~.~' /L~iLL / DATE PERFORMED: ~ - '?~ LEGAL DESCRIPTION: OL 1 2 /V~ L/G/V~ 3 VILLA C;,[ / SL(~PE 4 G/v,, 7 CEP..y .SANDy.., 51t..'rY (~.E A vEL / / SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER S ENCOUNTERED? I~ ~ OL P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Timel~I ~ Water F'T Drop ~ 3:07:00 i0 .~3 . t~ PERCOLATION RATE '~.'7 ~ ~inutes/inch) PERFORMED B,:~ ~'~j ~O"""O~ CERTIFIED B~.~~~4DAT~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES 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. # 1. GENERAL INFORMATION Complete legal description Lot 2; Block 3; Mountainside Village Location (site address or directions) 17601 Steamboat DRivz Property owner Mailing address Lending agency Mailing address Elizabeth McK~a,qu 17Aoi ~q:~ nmbnn~ 345-5673 Day pho~:Se4_44458 A~oh.n~ng~: AYnAhn 995 Day phone Agent Mike L~Wis PHH/HOMEQUITY 400 East Las Colinas Boulevard Address SuJ,¢~. Irving, Texas 75039 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Day phone 214-506-8808 TYPE OF WATER SUPPLY: individual well Community well NOTE: Public water TYPE OF WASTEWATER DISPOSAL: individual on-site If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. NOTE: 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 STATEMENT OF INSPECTION BY ENGINEER 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 application 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. 17034 Eagle River Leep Read Ne. 204 ~.gle ...... , Name of Firm Address Engineer's signature bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Phone bedrooms, with the following stipulations; Additional comments Date 7-27- ¢2. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates 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, 1/91) Back MOA #21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-OT~, ~'-~,/ /~OU~7,'~/v~.,~. ~'/zz_,.,~,~ Parcel I.D. A. WELL DATA Well type~ If A, B, or C, attach ADEC letter. Log present ~N) YES Total depth Sanitary seal (~N) Date completed Cased to ~.~' Wires properly protected ON) ADEC water system number /~///~' ~/8cf Driller ~),RcVtF~,R.T /~,'~¢.z.~,~- ~ Casing height /~ H FROM WELL LOG Date of test ~;/~'~ Static water level O,( ~ Wellflow /-/ -- ~,~ Pump level (,,{ ~', g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/~ tank on lot /00 ~- Absorption field on lot /00 r+ Public sewer main ~2//~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate (~."~z.L~ ¢'t~-/,¢_ Other bacteria _c/- ?.?.. Collected by: .. DATA Date installed Cleanouts (~1) High water alarm (Y/d~ Date of pumping Tank size /000 ~"/:~- Compartments "[-'t~O Foundation cleanout ((~N) ~Ni;)e¢. ~)EC~. Depression (Y/I~ ~,,~o /~//~ Alarm tested (Y/~) /t~ -PC'-~-~ ?--- Pumper ~-£/}FIC% [~U~¢plfVO ~,=_l~ltc~ SEPARATION DISTANCES FROM SEPTIC/t-h=u.4,~i TANK TO: Well(s) on lot I00 To property line I(~ Surface water/d rainage On adjacent lots Absorption field [Obi+. /00 ~¢- Foundation ~ / Water main/service line ~0 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Vent (Y/N) ~ High water alarm level Cycles tested Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" level at D. ABSORPTION FIELD DATA Date installed ~ [~"l Length I~'~'/ I~' .~' Width__ Soil rating !~ 'gF/~"A- System type T~-.,~CH :~_____Gravelthickness ~;" Totaldepth II z Total absorption area Depression over field (Y/~_~ ~J0.., Results (pass/fail) Peroxide treatment (past 12 months) (Y/O Cleanouts present (~)N) Date of adequacy test for ~ K~JOUJ~ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //00 ~"~ To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /06 ~.f Property line ]~ f& To existing or abandoned system on lot /U/,~ Cutbank /"///'+ Water main/service line ~O ~'/' 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 the date of this inspeciion. $ & $ ENGINEERING Signature 17034 Eagie ~ive~, LOop Road No. 204 , . Eagle Rlver~ Alaaka 99577 Engineer s Name Date HAA Fee $ / '~'~'~' ~ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 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 for INVOICE t 54662 Chemlab Re£.{ 92.2690 Sample # 3 Matrix: WATER Client Sample ID : L2 B3 MOUNTAINSIDE VILLAGE S/D PWSID : UA Collected : JUN 9 92 @ 12:15 Received : JUN lO 92 ~ 16:00 hrs. Preserved with : AS REQUIRED Client Name :S ~ S ENGINEERING Client Acct :SNSENGP BPOt : Req{ : Ordered By :R. SHAFER PO# :NONE RECEIVED Analyeis Completed : JUN 12 92 LaboratoYy Super/zisoF L,~TEPNEN C. EDE Releaeed By : ~~.~' Send Reports to: 1)S ~ S ENGINEERING Paramate~ Results Unite Method Allowable Limits NITRATE-N 0.74 mR/1 EPA 353.2 iO Sample SAMPLE COLLECTED BY: J.W. Remarks: I Tests Performed · See Special Instzuctions Above UA-Unavailable ND- None Detected *' See Sample Remarks Above NA- Not Analyzed LT-Lees Than, GT-Greater Than ~"~SGS Member of the SGS Group (Soci~t(~ G~n(~rale de Surveillance) bf0NICIPALITY OF ANCHORAGE DIVISION OF ENVIRO~IMENTAL WRALTH DEPARTMENT OF ~R. ALTH AND ENVIRONMENTAL PROTECTION A3PLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date Legal Description (include lot, block, subdivision, section, town. ship, range) (a) Location (address or d.irection~) , (b) Applicants Name /,~SoN C. ~fD~6 Telephone - Home (c) Applica. t .ts (check one) Lenins Institution (d) Lending Institution (e) Keal Estate go. & AEent Business ?? o3 ~-~ ; Owner/builder~ ; O 91'P' Telephone 'Z?Z'?y',37 Address Telephone (f) Mail the HAA to the following address: 2. TTpe of Residence Multi-Family ~--~ 3 Single-Family~ Number of Bedrooms 3. Water Supply Individual Well~ Other (describe) 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 0nsite ~ 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. [Page 1 of 2] 5. Ensineerin~ Firm Providin~ Inspections~ Tests; File Search~ Data and Information e 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 om-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- :ions in effect on the date of this inspection. (ENGINEER SEAL) bedrooms Disapproved DHEP Approval Approved for Approved ~ Terms of Conditional Approval CAUTION THE bfLtNICIPALITY OF ANCHORAGE DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~.~LTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PAAAGRAMH 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 REQUIRE- MENTS. 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF DEPT. OF FI~ALIiI ENVIRONMENiAL F'k L ~ [:CHOH NOV i 5 1984 A. WELL E~TA Well Classification Wen Log Present ,{y/w) y Total Depth '~ &5 / Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot Legal Description: If A, B, ~ C, D.E.C. ~pro~d(Y~) Yield ~9~ of ~outing. -- Pump Set At /00~- Sanita_wy Seal on Casing (Y/N) 7 Depression A~ound Wellhead (Y/w) M/ ; On Adjoining Lots ,,,v,,,~ To Nearest Edge of Absc~ption Field on Lot To Nearest Public Se~r Line ~//~ Clean t/ ole Water Sample Collected By ,, ~v, ~. Water Sample Test R~sults Co~nts )eo~- ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on LOt Date B. S, EPTIC/HOLDING TANK DATA / Date Installed ~./~ Size Standpipes (Y/N) / Air-tight Caps (Y/N) / Depression over Tank .(.Y/N) /~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~ ; fc~ -- Holding Tank High-Water Alarm (Y/N) -- Temporaz-y Holding Tank Permit !.Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply W~ll ldo~- To Building Foundation To Property Line /0~/ To Disposal Field ~ TO Water Main/Service Line Course ~/~t- / No. of Ccmpartments ~- Foundation Cleanout (Y/N) y W/~ To Stream, Pond, r~ke, c~ Major D~ainage Conm~nts A 3 -B ~t&'r ~'n-~. [Page 1 of 2] Receipt ~ Date Paid: Amount: z./~oo~o 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St. rata Date .Installed C~/~ ~' Width of Field ~ / Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test /~ ~.~. Type of System Design Length of Field ~ / Depth of Field ~) / Gravel Bed Thickness ~ / Stanc%pipes P~esent (Y/N) ~ate of Last J%~dgquacy Test -- Separation Distanc~ f'rcm A~sc~ption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/c~ Major D~ainage Course To D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea /OQ+ To P~operty Line ;L~ ~--'~20/ TO Existing or Abandoned System cn ; On Adjoining Lots ~//~ To Cutbank(if present) Cc~,~nts Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimsnsions Manhole/Access (Y/N) "Pun~ Off" Level at · Vent (Y/N) Pumping Cycles ~ing Adequacy Test. Meets MOA Co~ents ** Check Permitted Bedroc~ Rating Against HAA Bsquest I certify that I have checked, verified, or confcm~Ted to all MOA HAA Gu! on the date of thi Signed ~./~-~ ~.~ , Date //,/~/~.~ . .. / KB1/d5/s s in effect [Page 2 of 2] 2-15-84 Location: Client's Nam~: Address: BESSE~ EPPS & POTTS 2220 EAST 88 A~JE AN(~K~AGE, AK 99507 (9O7) 3~ S45t Subdivision: Lot: Slo~k: Tester: Initial Reading u~ Meter: Production Rate: 7.~ GP~ 24-Hour Capacity. -- C~llo~s