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Home My WebLink AboutPARADISE VALLEY BLK 4 LT 20Lo'T- i, I '~ 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 PHONE [] NEW MAI LiNG ADDRESS LEGAL DESCRIPTION LOCATION N~, OF BEDROOM8 I Well Absorption area Dwelling PERMIT NO. DISTANCE TO: ' ~ ~Z Manufacturer ~-~/~ Materiel~.~ ~ No. of compartments Liq. c~c~n gallons IF HOMEMADE: Inside length Width Liquid depth ~O ~ Well Dwelling PERMIT NO. DISTANCE TO: O ~ ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest lot Fine ~ PERMIT NO~ -- ,o. oflines/ Lengthofeachline~ Totallengt~nes Trenchwidth¢o inches ~' ...... b~ ~ Q~ Top of tile to finish graOe ~' Material beneath tile ~ i,ches T°taieffectiveTct:aroa 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 Distance to lot bne PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS i~,~h/ E;/~ P IC 8OIL TEST RATING INSTALLER H TIoA / APPROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT NO. ( 830639 ) FIPPLICFINT LOCFITiON LEGFIL ;, I DEPFIRTMENT OF HEFILTH FIND ENVIRONMENTFIL MROTECTION 825 ~L'~ STREET, FINCHORFIGE, FIK~ 9950t 264-4720 C~-~ .... SITE GHB CONSTRUCTION L20 B,':I. PFIRFIE:,ISE VFILLEY 2059 STONEGFITE CR 99502 ~44-.99t5 LO]' SIZE 999999 SQURRE FEET TYPE OF SOIL FIBSORPTION SYSTEM IS: DRFIINFIELD MFIXiMUM NUMBER OF BEDROOMS = 4 SOIL RFITING (SQ FT?BR)= t50 THE REQUIRED SIZE OF' THE SOIL FIBSORPTION SYSTEM IS: [:, E F" T ~-~ =- ~:-; L E ~'-~ ,3 T H = ? £~ ,3 F~-~ F~ "..-" E L [:, E F' T H = --~:: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRFIINFIELD. THE DEPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETWEEN THE SURFFICE OF THE GROUND FIND THE BOTTOM OF' THE EXCRVRTION (IN FEET). ~'F~E T~E~-~C:~ ~ ~ [],TH iS 5. (£~Z~Z~ FEET. ]'HE GRFIVEL DEPTH tS THE MINIMUM DEPTH OF GRFISEL BETWEEN THE OUTFFILL PIPE FIND THE BOTTOM OF THE E~CFIVFITION (IN FEET)~ PERMIT FIPPLICFINT HFIS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE INSTFILLFITION INSPECTIONS OF FINY WELLS FIDJFICENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THFIT THE NELL WILL SERVE. T'L..~C~ ( 2 ]:, ;[ ~s~SP'EE:T' Z 0 ['-.~"--q RF~:E F%"E,2~ L, I: RE[::. E:RCKFILLtNG OF RNY SYSTEM NITPIOUT FINRL.INSF'ECTION RND RPF'ROVFIL BY THIS DEPRRTMENT NILL BE SUBJECT TO PROLZ. ECUTION. MINIMUM DISTRNCE BETWEEN R NELL RND RNY ON-SITE SEWRGE DiSPOSFIL SYSTEM IS ±00 FEET FOR FI PRIVFI'TE WELL OR ±50 'FO 200 FEET FROM FI PUBLIC NELL DEPENDING UPON 7'HE TYPE OF PUBLIC WELL. MINIMUM DISTFINCE FROM FI PRIVFITE WELL TO FI PRI'¢FITE SEWER LINE IS 25 FEET FIND TO FI COMMUNITY SENER LINE IS 75 FEET. WELL LOGS FIRE REQUIRED FIND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN ]-':F~ DFIYS OF THE NELL COMPLETION. OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICFITION':] FIN[:' C:ONSTRUCTiON DIFIGRFIh'IS FIRE FI",.'FIILFIBLE TO INSURE PROPER tNSTFILLFITION. i CERTIFY THRT i: I FIM FFIMILiFIR WiTH THE REQUIREMENTS FOR ON-SITE SEWERS RND NELL::] FIB '~iET FORTH BY THE MUNICIPFILiTY OF FINCHORFIGE. 2: I WiLL INSTFILL THE SYSTEM IN RCCORD8NCE WITH THE CODE~. 3: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. R~IE:RNT G~B CONSTRUCTION "In the event that a lift station is installed an .... ; ..... . ,electrical permit snd inspection must be ...... ~ .............. ~ ................. ~- ~-4H-t~e~,lcal mspecz~on ts recewed i'n~his ' ~¢ office. The electrical work must be per- formed by a licensod electri.ciam". PERFORMED FOR: 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 LEGAL DESCRIPTION: ~/~dis~--., V( LttCV, Bic k Lot 20 " SLOPE SITE PLAN 2 5 6 , 7 9 10 11 12 13- 15- 16- 17- 18- 19- 20- COMMENTS ~¢.~ ..... ~ PERFORMED BY: 72-008 (6/79) WAS GROUND WATER IN ENCOUNTERED7 (~ IF YES, AT WHAT ~. DEPTH? Gross Net Depth to Net Reading Date Time Time Water D~ op TEST RUN BETWEEN WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol ~ Seophysicel Surveys Drilling Permit No. LOCATION OF WELL (Please Held either la, lb or lc.) A.D.L. No. Ic. IIDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL: Street Add~ess and Area of Well Location Feet SurfaceBel°~ 4. WEL~-~EPTH: (final} 5. 2. WELL LOG Material Type Top Bottom ~' :~q ~ Auger ~ detted ~ Bored ~ Other: ~:~*~ F ~ Irrigation ~ Heoharge ~ Commerlcei ~ Te~t Well ~ Other: e. CASm~~ diam. ~'~ ~ Weight lbs./ I0. STATIC WATER LEVEL: .~ / ft. / / ~ Above or ~.>Below land eurface I1. PUMPING LEVEL below land surface a~g~ 12.GROUTING Well Grouted: MaterJ~l: ~ Neat Cement ~ Other: ~Sub=. ~ det ~ Centrifical ~ Other 15. Wafer Temperature ~ F ~ C · 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 GENERAL INFORMATION (a) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name C¢,-~' Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,J~ulti-Family Number of Bedrooms Other WATER SUPPLY ', Individual Well~ Community [] 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 Onsite~~''' 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 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INI~ORMATION 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 ,,4 ~" c_~' _ Telephone -. ,~-4' ~ 3-'o VO Address / 2-¢ ~ ¢.~ '3 ~ .,4~,.,_ &. ~/~ ? '~ ~ / Date ~ ~% '-~ ~ ~ Engineer's Seal Approved fo'r'r .. --~'~'¢~ bedrooms by ~~/~'~'' Approved Y* ..... Disap~ "~ C'onditiona, Terms'of Conditional Approval ~ Date 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 to satisfy certain federal and state requirements. Employees of DHEP ~o 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 MUNICIPALITY OF ANCHORAG~' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL [HAA) CHECKLIST ~ FEBRUARY, 1984 264-4720 Legal Description: If A, B C, D.E.C. Approved (Y/N) Date Completed ~ - ,8 ;5 Yield Well Classification Well Log Present~) Total Depth B '7' Static Water Level -5~? ' Casing Height Above Ground Electrical Wiring in Conduit (~) Separation Distances from Well: Cased to ~, 't Depth of Grouting Pump Set At Sanitary Seal on Casing~,l) Depression Around Wellhead (Y/~ GPM ~ To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public-Sewer Line Cleanout/Manhole Water Sam pie Collected by Water Sample Test Resu'lts Comments ; On Adjoining Lots 1~0 7'. oo.; On Adjoining Lots To Nearest Public Sewer /o? /O-F -/~ c,o, To Nearest Sewer Service Line on Lot /v,4 : Date ~-I'Y -~-~- B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes Depression over-Tank (Y/I~ Pumping/Mainte~ ance Contract on File (Y/~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well / o / ' To Property Line 'f 7. To'Water Main/Service Line /o Course /oo ~ '* Size 1ooo No. of Compartments Air-tight Caps ~)/N) Foundation Cleanout Date Last Pumpea ; for Temporary Holding Tank Permit (Y/N) · To Building Foundation To Disposal Field To Stream, Pond. Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ Width of Field Type of System Design Length of Field ,5-~/' Depth of Field ~' · Square Feet of Absorption Area b~(~g ~'' Depression over Field (Y/~ Results of Last Adequacy Test /v'/t Separauon Distance from Absorption Field: To Water-Supply Well ! ~'o To Building Foundation '~'Ir ' Lot f¢,4 To Water Main/Service Line Jo ~-~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness 3 ' Standpipes Present~N) Date of Last Adequacy Test d~.~o, ftc Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ~/,4- D, LIFT STATION Dar e'~i~J~,....,.~ Dimensions "Pump On" Level aSize in Gallons t High Water Alarm Level at Tested for .... ~ during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Date ~' ~ ~'' $~ ~' ~ MOA No. Signed Company 4;~/~ ¢-¢ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) ' .~. APPLIf~'NT FILLS OUT UPPER HA:'~'~ ONLY Phone Property Owner - (~'C', ~ ~ '\ ' ~ ~ ~r~ ~ ZiPcOde ~ ~( ~ .~ ~ ~ ~ ~ ~ ~ ~ Mailing Addre~ [ ", t L~( ~ ~( .( ~ ~ ~, ~ ', .~ - Address Zip Code Lending Institution ~ ~>C" ~-)( {' 'L (). 2(~ 'uX~ _ Phone i.~ ~ Zip Code Address Realty Co. & Agent Phone Address Zip Code Type of Resi~nce ~ ~8inole Family ~Multiple Family No. of Bedroo~ ,~_ ~ Other Water Supply lndividual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~nd~vidua~ Y.~ ~ndividu~, ,n~t.,ed: ¢'V~ ~} ~ Public Utility When Connected to Public Utility: ~ (5 ~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Fie,d .otee: <2 C-O ~ J(... ~ ~' MUNICIPALITY OF"ANCHO~GE DEPT. OF H~ALTH ~ ~' ~' _ ~ ENVIRONMENTAL PROTECTION R C !vrn ( ~APP~OVED BEDROOM8 'CONDITIONS OF APP~OVAE ~ ~ ( ) DtSAPPSOVED Soils Rating Date ~wer Installed WellTo Absorption Area~ ~O ~ Well Log Received Novem~r 14, t983 Gary ~li s s 12140 Norway Drive Anchora ge r AK 99516 SuDject: Lot 20, ~tock 4, i~aradise Valley Approval ~or the individual sewer and water facilities cannot be granted until the following items i~k%ve been completed: ~ A well tog submitted to this office for our files and review. Pleas~ notify this Departn~ent for a reinspection whe~] the noted discrepancies have been corrected. I~ there are any further questions~ please call this office at 264-4720. Sincereiy~ CW23/ej/Ei Cory '~illis~ R.S. Acting Sewer & ~ator P rog ram ~a ~ g e r