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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- TI.II::!; 1..li!;N(!i'l't-I I::, :!: r"l'ri!:!'.,l'.iii; ]: CI1'.4 :!: ::i; TI.Il:: 'f'lllE Di:i:I.:'TI-I Cq:' I:::1 TI;i:EI'.,!C:I.I O',.;i: t:::':[T GI';;'.I:.)UH[) I'::11'.,1[::, 'l"l.ffi: t!!~OTT(::~M O1:;:' TI.II:: 'l"ll!!:i;l:;?.ti: :!; :i!!; NEI :!i;E'F 14 :( D'I'H FEd;;: 'i'lll!: Gt;;::l'T,?l:!:l.. I::,ti;F:"Tll ;I: i!i; TI.ii:i; M :1: i",! I:::ll'.,lt::, Till: !::=Erl"'fOM OF '1'1..1!: I:::' !:::¢.,!'.r' Till:: t::()I:;;:I'H !:!!',"," TI'ti:: 2: :!: !,.I ]: Lt. :1: N:i!i;Tl::ll .L. Ti.Iii:i: :ii;'.¢::!;l'l::!:M :ii:: :1: I...l!'.,!l::,l:!i:l:;i:_::i;Tf.:lt'.,il::, 'I'Hi::!'!" TI.II:i: 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