HomeMy WebLinkAboutMOUNTAIN VALLEY ESTATES BLK 2 LT 6
(~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
82.5 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
¢f, .... IPHON~ [ ~NEW --
GAl LIMO ADDRESS
~-~ Manufacturer~ ~ ~ ~. Materia~ ~ ND. of compartmants
~ Liq. c~>~i~,:allon, IF HOMEMADE: Inside length Width Liquid
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
O Well Found,tion / Nearest ,0t lin~(. PERMIT NO. ~7
~ DISTANCE TO: ~OO': Totallen~:line:/ Trent Ct~ ':- Distance betweeniiz:
~ No, oflines / Length of eac in,
inches
· ~N Top of tile to finish grad~/, Material beneath tile t'7~ inches :;:~;e ea
Length Width Depth
~u
~ Type of crib Crib diameter Crib depth i Total effective absorption area
~u Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot Hne PERMIT NO,
~ Building foundation Sewer line Septic tank Absorption area{s)
~ DISTANCE TO:
OTHER
PIPE MATERIAL~')
SOl L~S~ RATING/~
.p%~? DATE LEGAL
72-
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CONSTRUCTION TEST LAB
"One Test is worth a Thousand Opinions"
2204 Cleveland Anchorage, 'Alaska 99503 277-0231
Performed for Randy Richardson
Legal Description: Lot 6 ~'Block
This Fo~.n reports: SOILS TEST yes
Date Performed 9/21/79
2 ~ Subdivision Mountain Valley Est.
PERCOLATION TEST
Depth
Feet
Soil Characteristics
--£4 '
6" Peat, 6" Reddish Silt
Silty Sandy Gravel
Bottom of Test Hole
Was Ground Water Encountered No
If YES, What depth?
Percolation Rate Minute
Proposed Installation: SEEPAGE PIT DRAIN FIELD
Depth of Inlet Depth to Bottom of Pit or Trench
CO:.4MENTS: 1-50 Square Feet drainaqe area required per bedroom.
Test Performed by D. Paul 1// ~.~/~ , Data Certified By: Construction Test Lab
!~1~ 1 ~"~ Date : 9/21/79
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # (~')~t~-LoJ-\ \-~-q-q~ HAA# ~ (~,~c(C3\Lo(-o
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Descriptio~ (ir~clude 10t, block, subdivision, section, township, range)
Lot 6/ Block 2, Mountain Valley Estates
(b)
Location (address or directions)
NHN Birdsong
Property owner RDndy Richardson
Telephone: (home)
Business
Mailing Address
(c) Lending Institution Ak. dSA ECU Telephone
Mailing Address V~]~
(d) Real Estate Company and Agent R~/Ma×-
Address 166n~ ¢~n~r¢i~l~ Dr. ~201 ,~,~gl~ R~v~ A~- 99577
Telephone 694-zt?f~(h
(e) Mail the HAA to the following address: (or check here,}~¢', if hold for pick up.)
List contact person and day phone number below:
S & $ ENGINEERING
~7034 Eagle Ri.vet Leop Road No. 204
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE ......
Number of ~edrooms
Single-Family ~
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 th legality and status.
4. SEWAGE DISPOSAL
On-site ~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
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, lverifythat my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and sdequate 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 & S ENGINEERING
17034 Ea~le River Loop Road No. 204
Eagle River, Alaska 99577
Telephone
6. DHHS APPROVAL
Approved for ',:~ bedrooms by
Approved ~/~ Disapproved
Terms of Conditional Approval
Conditional
TheMunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval
cerificated 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 inordertosatisfycertain federal and state requirements. Employees of DHHSdonotconductinspections
or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
~ _~.~.MCJN.~CIPALITY OF ANCHORAGE (MOA) ~
(~_,'~j~."~',~i,q\s\O~lealth Authority Approval (HAA)
,,,~,~~"~' CHECKLIST - FEBRUARY 1984
¢~'~ 343-4744
Legal Description: ~¢~_~ ~ ~
A. WELL DATA
../
Well Classification ~ ¢ ~ ¥¢~ If A, B, C, D.E.C. Approved (Y/N) ~/~
Well Log Present (Y~ ~ Date Completed ~ t~ ~ Yield
Total Depth'~~'1¢
Static Water Level
Cased to _-¢¢c~1~ Depth of Grouting
Casing Height Above Ground
Electrical Wiring in ConduitS/N)
SFPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot \
To Nearest Edge of Absorption Field o~ Lot
To Nearest Public Sewer Line ¢~/~
To Nearest Sewer Service Line on Lot
Pump Set At
Sanitary Seal on Casing(45~/N)
Depression Around Wellhead (Y~
; On Adjoining Lot~ \
\~l~ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Collected b~' ~,¢~¢~ ~-'~'-%(-~tr'-~;:~:::~"~ ;Date
Water Sample Test Results ~,¢~'~_~-~~ '"- ~
Comments "~L)~.,~-~L~ ~ ~ ~ ~,~o¢=,_.
B. SEPTIC/HOLDING TANK DATA
Date Installed ~O~o-~ Size
Standpipes~/N) ~' Air-tight Capsd(~/N)
Depression over Tank (YZI:~ F~
Pumping/Maintenance Contact on File (Y/N~ /p
Holding Tank High-Water Alarm (Y/N)
No. of Compartments
"-/ Foundation Cleanout 4~7N)
ate Last Pumped '¢~¢~Z-~ -~
h~ ; for ~ -
/
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
\ ~r.~\-~' To Building Foundation
\.~::~ ~4- To Disposal Field
To Stream, Pond, Lake or Major Drainage Course
Comments "~-~ ~-----~ ~,~-~;~:::~-
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed lo - \ o
Width of Field "~
Square Feet of Absortion Area
Depression over Field (Y/~P
Results of Last Adequacy Test
Type of System Design "~¢'¢~
Length of Field ~
Depth of Field \ ~
Gravel Bed Thickness L~ ~
Statndpipes PresentCN) '~/
Date of Last Adequacy Test
To Water-Supply Well
To Building Founda~tion
Lot ~ /~
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
SEPARATION DISTANCE FROM ABSORPTION FIELD:
\ ,¢:~c::~ To Property Line \ ,=,t ~
\'Z..-~' ~ ''~~ To Existing or Abandoned System on
· On Adjoining Lots ~ ~¢f''
~, ~ ~ To Cutback (if present)
Comments
Dare. tailed
Size in ~
Dimensions
"Pump On" Level a~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Manhole/Access (Y/N)
"Pump Off" Level at
~ _._.Vent (Y/N)
dudng Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to ail MOA and HAA guidelines in effect on the date of this
........ ,!.; -,
inspection. '~,'.I'
Signed
Company
Date
MOA No.
~ :& $ ~NGINEERING
17034 Eagle River Loop Road No. 204
Eagle
Receipt No.
Date 0f Payment
Amount:
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
FEDERAL TAX ID # 92-0040440
ANALYSIS REPORT BY SAMPLE for Work Order ~ 12990
Date Report Printed: MAY 2 89 @ 16:32
Client Sample ID:L6, B2, MTN VALLEY EST
PWSID :UA
Collected APR 28 89 @ Il:lO h~s.
Received APR 28 89 ~ 15:30 hfs.
P~eserved with :AS REQUIRED
Client Name : S & S ENGR
Client Acct: SNSENGP
P.O.~ NONE REC'D
Req ~
Ordered By : RJS
Analysis Completed :APR 28 89 Send Reports to:
Labo~:atory Supervi,qor! :STEPHEN ~ EDE 1)S & S ENGR
Released By : ~d, ~ 2)
Special
Inetruct:
Chemlab Ref ~: 5067 Lab Smpl ID: 1 Matzix: WATER
Allowable
Parameter Tested Result/Units }4ethod Limits
NITRATE-N 1.4 ms/1 EPA 353.2 10
Sample ROUTINE SAMPLE.
Remazks: SAMPLE COLLECTED BY RJS.
1 Tests Performed ' See Special Instructions Above UA=Unavailable
ND= None Detected "See Sample Remarks Above
NA= Not Analyzed LT=Less Than, GT=Greater Than