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HomeMy WebLinkAboutSKYLINE VIEW BLK 1 LT 8 O 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 PHONE '~EW MAILING ADDRESS NO. OF BEDROOMS U ~ DISTANCE TO: ~0 ~ ~ ~ ~ ~ Manufacturer ' I Material No, of compartments Liq'capacityingalJ°ns~ IFHOME~DE: Insidelength~ ~ Width ~ ~ Liquid depth Well Dwelling PERMIT NO. Ma,~facturer ~h Material Liquid capacity in gallons ~ DISTANCE TO: Well ~A~ Foundation %~ Nearest lot line ~O PERMITNO. ~ ~O ~ ~ ~_ ~ No. of lines ~ Length of each line ~ Total length of lines¢.~ Trench widtl~ inches Distance between lines ~ OtI inches Total effective absorption~ ~area ~ Top of tile to finish grade ~1 ' O ,1 Materiel beneath tile Length Width Depth PERMIT NO, ~ Type of crib Crib di~e~r Crib depth Total effective absorption area ~ ~ ~11 Buildin~ foundation ~earest lot line m OlSTA~C[ TO: M~~r~st~ ~ ~ Depth Driller Distance to lot line PERMIT NO. '~ ~JO ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIAL¢ ~ ~ SOILTEST RATING 8 5' REMARKS A~~ DATE LEGAL 72-013 (R PERMIT NO. < ?8098? ) tPF'l.. I CRNT .OCRT I ON RRTHUR SFtYLES OLD BEEN HIGHNFt¥ SKYLINE VIEW SUB LOT SIZE 20125 SQUFIRE FEET FYPE OF SOIL RBSORBTION SYSTEM IS: TRENCt'i IR;4Ii'4LIM NUMBER OF' BEDROOMS = 4 SOIL. RRTING (SQ FT,-"BR)= 85 :HE REQUIRED SIZE OF THE SOIl_ ABSORPTION SYSTEM IS: THE LENCiTH DIMENSION IS THE LENGTH ,::IN FEET) OF THE TRENCH OR DRRINF:t:ELD. THE DEPTH OF ~ TRENC:N OF,' PIT IS THE r)ISTRNCE BEI'HEEN THE SURFRCE OF THE GF.'.OUND ~ND THE BOTTOM OF THE E;--',CRVRTION <IN FEET.'.',. THERE IS NO SET HIr.:,TH FOR TRENCHES. THE GR~VEL DEPTft IS THE: MINIMUM DFPTH OF GRRVI~"L BETHEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET). :'ERMIT RPPLICPINT t-IFIS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURII'.,IEi THE [NSTRL. L. RTION INSPECTIONS OF PINY WELLS FlDJRCENT TO THIS PROF'ERTY FIN[:, THE 'IUME:ER OF RESIDENCES TNFIT THE HELl_ HILL ':;ERVE. ~RCKFII".LING OF RNY SYSTEM P.!ITHOUT FINFtl". INSPECTION FIND RPPROVFll.,, BY THIS )EPFIRTMENT WILL BE SUBJECT TO PROSEC. UTIOI"t, IlNIMUM DISTRNCE BETWEEN R WELl.. RND ANY ON-SITE SEHAGE [:,ISPOSRI". SYSTEM IS ~lllO FEET FOR R PRIVRTE WELL.~ OR .50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBL. IC I.,iEl,.I ..... ~ELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~:~3 DRY':S .IF THE WELl_ COMPLETION, )THEM REQUIREMENTS MRY RPF'LY. SPECIFICRTIONS RND CONSTRUCTION DIRGRFtM.S; FIRE ~VRII_RBLE TO INSURE PROPER INSTRL, LRTION. i C'.ERTIFY THRT L: IRM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEI.,IERS RND t.,.IELLS RS SET :ORTH E.:Y THE MUNICIPFILITY OF RNCHORRGE. ]: I WILl_ INSTFJI"..L THE SYSTEM IN RCCORDRNCE WITH TI-IE CODE:S. i:: I UNDERSTRND THR'F THE ON-SITE SEHER SYSTEM MRY REC..!UIRE ENLFIRGEI',IENT IF THE ~:ESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. .:, I Gt'.IED: ~.~ ......................... iSSUED BY .................................................... DRTE ......................................... ',,,'ii:. 2 O Er E GEO,ECHNICAL Er DEVELuPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 6952774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOnG 688-2280 Soils E~ Foundations Land Development Performed for. Name. Mailing Addres : Legal Description:. Depth (feet) Sol) Charactertstic~ o Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No / If yes, what Drain Field~~- · '~' "~' Date: Performed by. -~_~ n 0 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 Location (site address or directions) Property owner Mailing address Lending agency Mailing address 19370 LupineStreet Chug.~k, AK Erick Borland Day phone 8600 Barney Circle Anchorage, AK 99507 562-7684 (w) 349-7354 (h) Day phone Agent Virginia Kohfield/ REMAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Cent~rfield Drive Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well X×X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX 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. Name of Firm S & $ ENGINE£RING~...--~ i2u;~4 Eagle Ri'c~Ct~'oop .R6ad No, 204 Address Eagle River, ,~l~i's~ 99,~77 .~- ' Engineer's signature ~~ DHHS SIGNATURE /'//"~ Approved.for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: Date The Municipality of Anchorage Dm~artment 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type Log present (~)'N) Parcel I.D. Total depth / ~ ~' Cased to Sanitary seal ~N) '~( If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~. c~ ,] % Driller _--1~'p.¢,~ /~ o Casing height Wires properly protected (~)N) k.( .g.p.m. FROM WELL LOG Date of test Static water level Well flow -'~\ , c, Pump level1 0 ~- SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION ; On adjacent lots ; On adjacent tots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~ ¢ \~. -%'5 B. SEPTIC/HOLDING TANK DATA Collected by: __ Other bacteria $ & S ENGINEERING l~)~l-Eag~er E~gle River, Alaska 99577 Date installed Cleanouts ~¢~N) High water alarm (Y~) Date of pumping Tank size \'7--~---?c~ Compartments Foundation cleanout (Y/~ ~ Depression (Y/~ Alarm tested (Y/N) ~-~ .-- "~- o ,.. c~ ~ Pumper ....3~¢--. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _ \ ,._~ '''~ On adjacent lots \ ~ Foundation ,~" To property line \ © ~'¥'- Absorption field ~i~I Water main/service line Surface water/drainage \ ~'~ 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level ~ ¢¢jrdl~'~ te'"'~sted Meets MOA electrical codes (Y/N) S~E FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed _ ~ '~i '~ ~ Length '~"[ \ Total absorption area _ Date of adequacy test. Width Z~;,¢-¢,-~ ~ Cleanout present (~N) _. k/ Water level in absorption field before test z~ ~ Peroxide treatment (past 12 months) (Y(~) ~o~ ¢._ ¢---~,o ~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot t. o ~ t '~ To building foundation ~. On adjacent lots --~ ~ t Surface water \ ~.~ C:~ \ Curtain drain ~-~ /A- E. ENGINEER,S CERTiFiCATiON Soil rating (GPD/FF) ~--~ Gravel thickness System type _ Total depth . Depression ever field (Y4~ ~( for /~ Bedrooms After test If yes, give date On adjacent lots \ o ~ x.V-- Property line To existing or abandoned system on lot. Cutbank ,'~ l/4- Water main/service line Driveway, parking/vehicle storage area Signature $ & Engineers N~j¥~, ' -"~'~~77 I certify that I have checked, verifiea or conformed to ali MOA and HAA gu/de/ines in effect ~n.the dat~e of this inspect/on. Waiver Fee $ Date of Payment Receipt Number HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back 1~:00 CT&E ENU! RONMENTAL LAB SERU! CES COMMERCIAL TESTING & ENGINEBRING~CO. ENVIRONMENTAL LABORATORY SERVICE8 : REPO~F of ANALYSIS Chemlab Ref,~ :93.4220-1 Client Sample ID :La Bt SKY[,INE VIEW Matrix :WAT~ G633 B STREET ANCHORAGE. AK 99518 TEL~ (f~07) 562-2543 FAX. (907) 561-5301 Client Name :$ & S ENGINEERING Ordered By :R, Project Name ProJect~ : PWSlD :UA Sample Remarks: ~OU?INE SAMPLE COLLECTED BY: RAY, WORK Order :69851 Report Completed :08/23/9~ Collected t08/19/93 @ 16:00 hfs Received :08/20/93 @ 11:25 hfs Technical Director~BTE~J~-C~, QC Allowable E×t. Anal Parameter Results Qual Units Method himits Date Date Init Nltrate-N 2.65 ~/L EPA 353.2/300.0 l0 08/20 5~i * 'See Special ~nstructions Above ' UA.:= Unavailable. .... '?*_~ See S.a. mple Remarks; Above,-, : · - .- · '~ - : ~},NA~= .Not AnalYzed "~ :,:)r,~-/,ENVI,~ENTAL SERVICES IN ALAsKA,xCOLORApO;-U!AH, I[UNO~$, OHIO, MARYLAND, WEST V~ROtNIA 'NEW JE,~SE~,.SOUTH QAROLINA APPLIF :NT FILLS OUT UPPER HA' PrbpertyOwner..~ Mailing Address .~..:' Buyer Address 'ONLY Zip Code ,~,.,,~,.~. ~,, Zip Code Phone Realty Co. & Agent Type of Residence ~Single Family ~ Multiple Family No. of Bedroo~4~ ~ Other Phone ? ~/¢/' >~./L~' Phone /-~,'," Water Supply ,," Individual Community ~ Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available). Sewer Disposal  I ndividual Public Utility ~ Holding Tank Year Individual Installed:_ / ,~ '~ When Connected Io Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date i/- Inspecler Inepector Inape~lor Inapector Field Notes: ~,~J_ ~) ~ ~ ~ MUNICIPALITY OF ANCHORAGE ( ~PRBOVED BEDROOMS 'CONBITIONS OF APPROVAL ( ) DISAPPROVED ) co..,~,o.,. .~v%. Soils Rating [ Oate,werlnslalled Well To Absorption Area ¢ Well Log Received 'ff~ ? EXCAVATION ROBERTA. SHAFER WORK November 22, 1982 CIVIL ENGINEER 694-2979 Red Carpet/Greatland Realty ATTENTION: Terry Kruger P.O. Box 633 Eagle River, Alaska 99577 A4UNIcPANi¥ OF ANCHo~'AGF_ OFt,/ r~ . ENVIR 3,#, :/', A. .L~ Dear Mr. Nruger, 'Reference: Lot 8~ Block 1: Slcyline View Subdivision A sewer system adequacy 'test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified 'to have a capacity of 1250 gallons in accordance with Municipality records. The absorption trench was tested by a continuous flow of water over a period of 24 hours without any adverse effect on the system. It can be concluded from this 'test that the waste water disposal system serving the two bedroom residence located on 'this property is currently functioning adequately. However, 'this system cannot be guaranteed against subsequent failure. If we may be of further service, please do not h~sitate to call. Si~ly,. cC: Municipality of Anchorage Department of Health and Environmental Protection SR8 196X EAGLE RIVER, ALASKA DA3~r: RECEIVED INSPECTION APPOINTMENTS ~TIME TIME TIME 'NSPECTOR  DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION DEPT. OF I::ALTH & 825 L Street - Anchorage, Alaska 99501 JENVIRONMENI,,:,,L i, ~'TECTION ENVIRONMENTAL SANI'rATION DIVISION FEB 2, ~ I980 Telephone 264-4720 ..ou.s..o.A...OVA. o. DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing, 1, PROPERTY OWNER PROPERTY RESlDEN~ (If different from above) PHONE MAI LING ADDRESS -- 5. LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF~SEDRO0~9' I~"SINGLE FAMILY [] One L~K Four [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPELY [~"'1NDI VI DUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) E~ INDIVI DUAL/ON-SITE** [] PUBLIC UTILITY / ~ 7 ~'" YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) l~J -- THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1, TYPE OF RESIDENCE [] ONE [] THREE [] F~VE [] OTHER [] SINGLE FAMILY [] MULTIPLE FAMILY [] TWO [] FOUR [~3 SIX ~ERMIT NUMBER 2, WATER SUPPLY [] iNDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ~ ~ERMIT NUMBER 3. SEWAGE DISPOSAL SYSTEM [] INDIVI DUAL/ON -SITE }ATE INSTALLED E~ PUBLIC UTILITY Connection Verified. iNSTALLER [~]SepticTank or ~Holding Tank ._ Size:_~,~'C-) If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK V1ANUFACTURER TOTAL ABSORPTION AREA MATERIAL ~ ~"-'~'~'¢~ ..... Nearest Lot Line Septlc/Ho,dingTank ,Absorption Area ~werLine _~ 4. DISTANCES WELL TO: /~-O -- -- Absorption Area to nearest Lot Line 5. cOMMENTS ~APPROVED FOR _ ~ BEDROOMS [] CONDiTiONAL APPROVAL (letter must accompany certificate) DATE ~ BY -- 72-010 (Rev. 6/79)