HomeMy WebLinkAboutPARADISE VALLEY BLK 4 LT 7
~ 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
J~NEW
[] UPGRADE
NAME
MAILING ADDRESS
~To N F--.6AT~
LEGAL DESCRIPTION
LOCATION
D,STANCE TO: I We,,/~
Manufacturer __ .
/~ ~ IF HOMEMADE:
'q. p ' y. g
D, TA C TO: I
Well
DISTANCE TO: I
No of line[ Length of ~qh line
Top of tile to finis grade
~ngth Width
~TANCE
TO: Well
lCI~s Depth
DISTANCE TO: Building foundation
'-~A l~Ab 17_ E
~-IV F-----
Absorption area
Inside length
Dwelling
Dwelling
N~T IN
Material
W dth
Material
Foundation Nearest lot line
NeT li~
Trench width
Total leng~t~ o~ines
Material beneath tile
Depth
Crib depth
Building foundation
inches
inches
NO, OF BEDROOMS
PERMIT NO.
No. of compartm._~pts
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO ¢'
Distance between lines
Total effective absorption area
PERMIT NO,
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Driller
Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST RATING
i~,C
D,fL~b i
INSTALLER
REMARKS
APPROVED
DATE LEGAL
72-013 (Rev. 3/7~)
PERMIT NO.
RPPLICRNT GRRS' BLISS
LOCRTION
LEGRL L?B4 PRRRDISE ',/FtLLEY
DEPFIR"(MENT CIF HEFILTH RN[:, EN,. IRLNtlENtHL F'NO'IEr£:fICN
,:,~:._ ."L"7 STREET., RNL. HURHmE, FIK, g~50±
'26.4-472E.~ '--'
( 83:04]:8 ',
'~'""-'=9 3:44.-99t5
,::.,._.,...,_ STONEGRTE CIRCLE 99502
LOT SIZE 999999 SQLIRRE FEET
TYPE OF SOIL HE,:,LFFII.N ...'r_TEH TRENCH
MRXIMUM NUMBER OF' BE[:,ROOMS = ]: SOIL RFITING ,.'.'SQ FT,.."BR)= :1.~._
THE REQUIRE[:, SIZE OF THE SOIL RE:SORF'TION .:.'r.:,TEH '"?'
[:"EF"]-H= ? L_ E 1'-.I L--:~ IF b-I = 4.7-" G F-.' Fi %-" E ~ ....... E:, F- F' T H ""~ 4
THE LENGTH DIMENSION IS 'THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 TRENCH OR PiT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND 8ND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMLIM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXC8VBTION (IN FEET).
F'ERMIT RPF'LICRNT HRS THE F..E:,FUN_,IE, ILITY TO INFORM THIS [:,EF'RR. TMENT DLIF..IN~ THE
INSTRLLRTIEN INSPEL-:TIONS OF RNY WELLS RDJRCENT Ti] "['HIS F'ROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
'Tb-~C, ,:: ~-'~_-_" ]:, I t'~:;F"EC:T I C'~-~$ RF-:E F-:E G:., LI ][ F:E[:,
E:RCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RN[:, RF'F'R.O'v'RL E:Y THIS
DEF'RRTMENT WILL BE SUBJECT TO PROSECLITION.
MINIMUM DISTRNCE BETHEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
±00 FEET FOR R F'RIVRTE HELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL..
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
'TO R COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS
OF 'THE WELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRL. LRTION.
F"E-] F-."I"""I :[ T' E::-=:F' ][ ~.~.." E 5 [..- EL-E! 1E. EF? 2-:1..
I CERTIFY THRT
±: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLI]"Y OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3: BEDROOMS.
SIGNED: ~ ...... ~_~-- ...... ~-~ .............. RPPLICRNT GRRY BLISS
i SS lED E'Y ''~ ~'''' ' ' ....
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 Lo Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
[] SOIL~ LOG
[] PERCOLATION
TEST
PERFORMED FOR: g~.C~: ~,~..
LEGAL DESCRIPTION: ~C~' ~
SLOPE
DATE PERFORMED:
SITE PLAN
DEPTH'
1
2
3
4
5
6
7
8
9-
10-
11
12
13
14
15
16
17
2O
COMMENTS
PERFORMED BY:
72-oo8 (6/79)
WAS GROUND WATER ~, }O t~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
A.E.C.S,, INC.
]??0 W. 2511-1. AVENUE
ANCHORAGE, AK. 99501
subdivision
Supplemen[a] Soils Informal:Jori.
LOT 7 LOT 7
I
TH TH
LOT '"7
8 8 8
10 10 !o
11 11 11
12 12 12
13 13 13
14 14 14
15 15 15
16
~ 17
18
19
16
17
18
19
16
17,
18
19
LOT 7 ' I~1
TH ~ 1~I
5
7
8-
9
10
11
12
13
/'14
15
16
17
18
19
LOT '~
TH 5'
2
3
4
7
'9
10
11
12
13
14
15
16
17
18
19
20
, Subdi vlsi on _ CQy'~.
~.~ LOT ~
", TH b
2
5
6
8
9
10
~2
~3
~5
~6
~7
~8
~9
20
A.E,C,S,, II4C.
t220 W, 2Fll-I, AVENUE
RtCHO?~qGE, AK. 99501
Supplement. a]. Soi.lcI Inf*ormation.
LO1 ~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
17
18
19~
20
LOT ~
.T.~U. ¢¢
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOUEES
Division of Geological ~ GeophysicolSurveys
Drilling Permit No.
LOCATION OF WELL (Please complete either la~ lb or lc.) A.D.L. No.
Ia.I Borough Subdivision Lot Block I~.I I/4qtrs. Section No. Township N[~ Range El'-] Meridian
Anch 7 4 _of_of_of-- s~ wr~
,c.JlO,STA,CE A.O D,RECT,O. FROM ROAO,.TERSECT,O.S 3. OW.ER OF WE..= Gary Bliss
]?aradise Vslley Address:
Street Address and Area of Well Location
2. WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
Surfoc. 83 f,. 6 -- __--83
M eterial Type Top Botfom
sandy gravel w/cobbles 0 38 S. rUoob,e too, X~E]Ro,ary []]Driven C]Oug
hardpan 38 71 rq A.ger O Jetted []Bored E] O,h.r ~
grayTblue cemented clay & 71 ~1 7. USE:~Oomesf~c [] Public Supply [] I.dusfry
~ravelv tight w/water gravel 81 lg'~'~ I [] ,~r~ga,,oo [] R. chorgo [] Con.or,ca,
-- ~ [] Test Well [] Other;
15 gpm a. CASING, [] Threaded ~ Welded
diam. 6 in. to 83 ft. Depth Weight__lbs./ft.
diem. in. to ft, Depth Stickup__ ft.
9. FINISH OF WELL:
~,UNIC[~ALtT¥ 0~: /~ cHORAG~ Type: Diameter:
DEPT. OF
.O~.Cyj(')~.,1 Slot/Me sh Size: Length;
f:t~,,/[RO~M~tAL Set between ft. and ft.
~.~ ~_) ~)0 Backfilling Gravel pack
,o. STATIC WATEB LEVEL= ft. / /
RErr. lV o
%~ I.. ~ - [] Above or [] Below land surface
Equipment ussd:
II, PUMPING LEVEL below lead surface ond YIELD
_ ,,. p mp,no g.p.m.
~,~,c~ __ft. after hrs, pumping g.p.m.
12.GROUTING Well Grouted: [] Yes ~No
Material: [] Neat Cement [] Other:
t3, PUMP: (if available) HP
Length of Drop Pipe ft. capacity g,p.m.
[] Sabra. [] d.f [] Cen,rifico~ [] Other
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Water Temperature __o [] F [] C
This well was drilled under my jurisdiction and this report is lrue to the best of my knowledge and belief;
Alaska Now-Well-Vern's Drilling &Ent. AA3327
Registered Business Name Contract License Number
Ad~e~ 12241 Avian, SRA Box 1560 Anch.,Ak 99507
S,gne : o.,e: 'V - S
AuthorFZed Representalive
Form OZ-WWR (11/81) Copy Distribution: WHITE-Stole DGGS~ PINK-Driller~ CANARY-Customer
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~ ~LI% ~ Telephone: Home ~- Business ~' -
Applicant Address ~5 ¢~
(c) Applicant is (check one): Lending Institution ~; Owner/buitder~; Buyer ~; Other ~ (explain);
~,~'(d) Lending Institution
Address
Telephone
-,---.~(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family~. Multi-Family i'-I
Number of Bedrooms ~
WATER SUPPLY
Individual Well~(¢ Community
[]
Note: If community well system, mu~
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite[~. Public [] Communit'.
Note: If corn munity well system, mu=
attesting to the legality and status.
Other
Page 1 of 2
5. ~ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, D~A 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, 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.
Name of Firm . .~.~--~ E~/¢ / ~"~ ~?~'~'/~'~'2 Telephone '~4~- ')-''~,~' Z''
Address /2 ~ ~ ~, ~ ~ ~1~ ~ ~ ~~ ~ ~~
Date 7~-~ ~
Engineer's Seal
o Robe' ~' e - ' ~ D. Schilling
%.~ ~ CE-1411
~ ~'~~ ~~ Date ~ /~' / ~
*..roved,or d,ooms - %-_. ;,Td -
~pprovod ~ ~isapprov~ ' ~onomona~
Torres of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this asa courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. 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.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MO~
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Leg.al Description: /..o'7- '~
MUNICIPALITY OF ANCHORAOE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
WELL DATA
Well Classification Pl?-I't,)~ If A. B. C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~ Date Completed ~ ~ ""~ Yield (~'- ~ ~'~'~
Total Depth ,~ -5 ' Cased to ~' ~ ' Depth of Grouting /
Static Water Level /u'"o~' .~ f.,,,,',~.~t /~..,~ Pump Set At //./~'~
Casing Height Above Grouna
Electrical Wiring in Conduit [Y/N)
Separation Distances from Well:
T~Holding Tank on Lot
Sanitary Seal on Casing (Y/N) ~'
Depression Around Wellhead (Y/N) ~
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /4~ ~ ; On Adjoining Lots 42~v
To Nearest Public Sewer Line A~..~_,~ To Nearest Public Sewer
Cleanout/Manhole __z/./..,~/ To Nearest Sewer Serwce Line on Lot
Water Sample Collected by /~-./~ .~'~,'//, ~, ; Date ~- '~ ~---
Water Sample Test Results .'"~-~c~ ~'
Comments
B.~OLDING TANK DATA
Date Installed ~--~ ' '~-~' ~ Size ¢/~ ~ ?~-,~, No. of Compartments '"2_.
Standpipes (Y/N) r' Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) /V~ ~ Date Last Pumped / (..,)~....~'...,
Pumping/Maintenance Contract on File (Y/N) -'4~..~/_-~-'~-- ; for
Holding Tank High-Water Alarm (Y/N) .~'~'.-~'...~: Temporary Holding Tank Permit (Y/N)
Separation Distances fron~olding Tank:
To Water-Supply Well ~ ~ o"
To Property Line ~
To Water Main/Service Line
Course
To Building Foundation
To Disposal Field ~'
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed b - ~;-4~'~:~
Width of Field '~ · -~ /
Square Feet of Absorption Area
Depression over Field (Y/N) ~
Results of Last Adequacy Test
SeparatiOn Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot /1~,//,,~
TO Water Main/Service Line
Type of System Design
Length of Field '~ ? !
Depth of Field '~ /
Gravel Bed Thickness 4 /
Standpipes Present (Y/N)
Date of Last Adequacy Test
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 D, J~.~
To Cutbank (if present)
!
D. L, FT STAT, O.
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test, Meets MOA
Comments
** 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 this inspection.
Signe Date
Company ~L~___C-,4~ ~/,,,,~;~.,,.v,~ MOA No.
Receipt No. ~.~"
Date of Payment
Amount: $ Engineer's Se~l
Page 2 of 2
72-026 (11/84)
IV. DIAGRAM OF SY$'TEMIS)
/"'~ INSTRUCTIONS FOR DIAGRAM / -~
1. ~ ;' ;l~n ;law, locate and identify each et ,.,e following:
a) Well b) All Structures e) Septic Tank d) Soil Absorption System
e) Surface Water f) Sources of Contamination g) Property Line (include Dimensions)
h) Closest well on an adjacent property i) Closest septic tank on an adjacent property
j) Closest edge of an absorption field on an adjaca, nt property
2. Show distances between the well and each of the other items listed in 1. . '
3o Show distances between water bodies and each of the other items listed in 1.
4. In · cross section view of the soil absorption area, identify each component and show the depth (thickness) of the following:
a) Soil Cover b) Absorption Material c) Water Table d) Bedrock e) Discharge Pipes
349-5552 (Office)
AREA Engineering
1207 E. 74th Ave. Ste. 203
Anchorage, AK 99518
562-2161 Ext. 583 (Message)
August 5, 1986
MunicipalitY of Anchorage
DHEP
Anchorage, AK
ATTN: SteYe Morris
Re: HAA, Lot 7, Block 4, Paradise Yalley Subd.
Dear Mr. Morris:
This is to confirm the information that I gaYe to you earlier today by phone
about the referenced property. Th~ property owner, Mr. Gary Bliss, has informed me
that he is not going to pursue obtaining approval of his well as Class "C". The
property that had been connected to his well, Lot 8, now has its own well and the
old service line has been rendered inoperable. The well dr±~ler, Sommerville Well
Drilling, removed the keybox and seYeral feet of the service line and then backfilled
the site.
In my opinion, Mr. Bliss' application can now be processed. I have attached an
updated as-~uilt drawing showing the facilities on his lot and also the location of
the new wall on Lot 8. Please call me at your convenience if you haYe further
questions.
S inc er ely,
Robert D. Schilling, P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WA'i'ER FACILITY
264-4720 "
Application Date
,/
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 7 Block 4 Paradise Valley Subdivision
Location (address or directions)
18140 Norway Drive
(b)
(c)
Applicant Name Gary Bliss Telephone: Home 345-5878 Business ~me
Applicant Address 18140 Norway Drive~ Anchorag_e~ Alaska 99516
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Will_pick up
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms (3) Three
Other
WATER SUPPLY
Individual Well ~ Community [] Public E]
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
Onsite ~ Publicl-I Community I-I Holding Tank []
Note: If community well system, must have written cohfirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72~025 (11/84)
Page 1 of 2
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, 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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm Telephone
Address
Date
Engineer's Seal
This office has received written confirmation (in the form of a puming receipt
from Alaska Pumping & Line Cleaning Company) that the conditions of July 1, 1985
have been met. Therefore, this property meets MOA requirements.
Date .
Approved for (3~ Thre~ bedrooms by ' ~_--.~,..j._~ _~tu-~ ? - 1 q~5
Approvea ~. Disapproved __ Conditional~
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 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 Io satisfy certain federal and state_requirements. 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.
Page 2 of 2
72-025 (11/84/
MUNICIPALII~f OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR ~ALTM AUTHORITY APPROVAL CERTIFICATE
Application Date
1o General Information
(a) Legal Descri~tion (~ncJ~4de 1.or, blqck,., subdivision~ section, township, range)
Locatiom (address or directions)
(b) Applicants Name, s%cf ~/:~ Telephone - Home Business
' ....
(d) Lending Institution Telephone
Address
(e)
Real Estate Co. & Agent
Address
(f)
Telephone
Mail the HAA to the following address:
/ ~/ , ~,~ ,~. , ,~
~esidence
Single-Family~
Number of Bedrooms
Multi-Family
Other (describe)
Water Supply
Individual Well ~ Coma, mit7 ~ Public ~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
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]
!
~irm Providin$ Inspection~ Tests~ File Sear. ch~ Data and Inf
As certified by my seal affixed hereto and as of the validation date shown below,
that the on-~£~.
vezify that ~ investigation of this He~th ~thority Approval sho~
wa~er supply a~/or ~stewater disposal system is safe, f~ction~ and ~eq~te for
~he ~ber of bedrooms a~ ~pe of s~ructure i~icat~ herein.. I further verify that~
based om ~he i~o~ion ob~ain~ from the ~nicipali~y of ~chorage filee and from my
investigation ~d inspection, the on-site ~ter supply and/or ~stewater disposal
system is in compliance ~th ~1 ~nicipal and State codes~ ordinances, a~ regula-
tions In effect om the date of this inspection.
c.
D~P Approval~ No. 2251-~
Approved for/~fW~ _ bedrooms By
Approved Disapproved ~
Terms of Conditional
nditional ~
CAUTION
THE MUNICIPALITY OF ~NCHORAGE DEPARTMENT OF ~ALTH AND Ekr~IRONME}~fAL PROTECTION
(DHEP) ISSUES ~rgALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE P~EPRESENT-
ATIONS GIVEN IN PAi~AGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COb~RTESY 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 TH~ PROFESSIONAL ENGINEER'S WORK°
(DHEP SEAL)
RR.4/eJ/D18
[~age 2 of 2]
7-19-84
ae
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
Well Classification
Well Log P~esent ~b/N)
Total Depth ~ ' Cased to
Static Water Level AYd~ ~
Casing Height Above Ground
Electrical Wiring in Conduit ~)
Separation Distances from Well:
To Septic/Holding Tank on Lot
MuN%CipALITY OF ANCHORAOI:
DEPT. OF HEAIJH &
ENVIRONMENTAL pRoTECTION
Legal Descriptio~n: -/"///bt /P,.,.~&L.)
.Lo-,' 7
If A, B, c~ C, D.E.C. Approved(Y/N)
Date Completed ~/~ Yield/~-~
~ ~ ~ Depth of Grouting
Pu~p Set At fgYQ~67h (~JE// ~ ~
Sanitary Seal on CasingS/N)
Depression Around Wellhead (Y~
; On Adjoining Lots /O-D
TO Nearest Edge of Absorption Field on Lot I~! ; On Adjoining Lots
To Nearest Public Sewer Line ~t)/~ To Nearest Public Sewer
Cleanout/Manhole ~%7~/~ To Nearest Sewer Service Line on Lob ~/~
Wate~ Sample Collected By /~]~/"F) ; Date
Water Sample Test Results ~.$~/Z~ ~
Co,~,ents
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/~/~ Size /DOC) No. of Cu~gartments ~
Standpipes ~N) Air-tight Caps ~) Foundation Cleanout (Y/~
Depression over Tank (Y~ Date Last Pumped ~
Pumping/Maintenance Contract on File (Y/N) A)/,6- : for ~3{~t
Holding Tank High-Water Alarm (Y/N) ~-~{~4~ Temporary Holding Tank Permit (Y/N) m/W
Separation Distances f~om Septic/Holding Tank:
To Water-Supply Well /~O~+ To Building Foundation ~/
To Property Line /(p{.~ To Disposal Field ,_~"'"
To Water Main/Service Line A]/~ To Stream, Pond, Lake, c~ Major Drainage
Course
Receipt ~
Date Paid:
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~/~7/~ ~
Width of Field ~,~ /
Square Feet of Absorption A~ea ~7~
~-~ Type of System Design
Length of Field ~7
Depth of Field ~ ~
Gravel Bed Thickness
Standpipes P~esent
Depression over Field (Y/~ Date of Last Adequacy Test ~f~,~4~
Results of Last Adequac~y Test ~%6%m.
Separation Distance from Absorption Field:
To Water-Supply Well ~ /~ To P~operty Line ~-6; /
To Building Foundation ~// To Existing or Abandoned System
Lot ~J ~ ; On Adjoining Lots ~ ~ ~) /
To Water Main/Service Line a3~ To Cutbank(if present) A]/~,.
To Stream/Pond/Lake/or Major Drainage Course /OOt-~ '~
To Driveway, Parking Area, c~ Vehicle Storage Area ~-~ ~
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water AlarmLevel at
Tested for
Electrical Codes (Y/N) AJ/~
Comnents
Dimensions ww~
Manhole/Access (Y/N) ~J/~
"Pump Off" Level at ~
Vent (Y/N) ~/~
Pumping Cycles du~ing Adequacy Test.
~eets MOA
Check Permitted Bedrocm Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA
on the date of this inspection.
S igne d,~ ~ ~'/~,~~?
Company
KB1/d5/s
[Page 2 of 2]
Date
2-15-84
APPLI('%,NT FILLS OUT 'UPPER HAt'''''~ ONLY
Pro, p~r ty .Owner._. ~C? ~ ~ {~ ~ ~ ~ ~ ~ ':;' '~ Phone
Mailing Addre~ ;~ (~?"'~;~ , ': ~( '{~ (' (~t ( ~ --
Buyer ~'~ 1
Address Zip Code
.,one
~ Zip Code
Realty Co. & Agent
Zip Code
Legal Description ~'~
Type of Resi~nce .....
~ Single Family
~ Multiple Family No. of Bedrooms .r '
~ Other
Water Supply
~ Individual ~O,,-~" A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach Icg if available).
Community
Public Utility
~ Individual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OOESSlNG CAN BE INITIATED.
Time ' Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
Field Notes: MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTfl
)~[ ~ ENVIRONM2NTAL PROTECTION
A ~f 0C, T ~ ~983
RECEIVED
( '~APPROVE[~ B-'~-ROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL*
Soils Rating Date Sewer Installed Well To Absorption Area ;/f~, Well Log Received
72-023 (31&~)
~ ~ 1983
October t3,
Gary H. Bliss
2059 Stonegate Ct.
Anchorage, Alaska 99502
Subject: Lot 7, Block 4 Paradise Valley
Approval for the individual sewer and water ~acilities cannot
be granted until the following items have been completed;
o The road to your property was impassable. When the road is
repaired please contact me for the on-slte inspection and
water sample.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected, if there are any
further questions, please call this office at 264-4720.
Sincerely,
Jim Roberts
Associate Environmental Specialist
cc: Alaska l,~utuai Bank
Gary It. Bliss
2059 Stonegate Ct.
Anchorage, Alaska
October 24,
99502
Subject~ Lot 7, Block 4 Paradise Valley
Approval for the individual sewer and water facilities cannot
be granted until the ~ollowing itel~s have been completed:
o A %~ell log s~bmitted go this office for our files and
revie%~.
noted discrep~i~s have been corrected. If there are any
further questions, please call this office at 264-4720.
Sincerely,
Jim Roberts
Associate Environmental Specialist
JR59/E2/s