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HomeMy WebLinkAboutSKYLINE VIEW BLK 2 LT 20 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 MAILING A%SS LEGAL DESCRIPTION PHONE LOCATION /Welb / Absorption, area i Dwelling ~.. 0 I DISTANCE TO: I /O(..~ I /F~ _ v / Mated~_ ~ ~ Manufacturer Liq. cap~i~ i~qalJons I ~ ~~ Inside length Widt~ i ~ ~ ~ ~ DI STANCE TO: Well ~ ~llIng ~ ~ ~ Manufacturer //~ Material . Well / Foundatio ,I DISTANCE TO: I //~ ~/ Nearest~Se' ~I~ ~ IN°' of lines Length ~,i¢ Total len~*¢s Trench inches ~ /Top'oftiletofinishgrade ¢, Materialbeneathtile ~ ~on~th ~idth ~/' ~eoth ~inches ~ /~ ~ Type of crib Crib diameter ~ Crib depth ~ / Well / ' Building foundation Nearest lot line DISTANCE TO: j ICJass . ~ Depth t / Driller ~ / DISTANCE ¢~ / BB"d~g f~n~a~on~ Sewer line OTHER PIPE MAT ERIAL~S SOIL TEST RATING / INSTALLER REMARKS NO'OFBEDROOML.~ No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines~.~ Total effect~.~b~o_~rea ¢/ PERMIT NO. ' TotaJ effective absorption area Distance to lot line Septic tank PERMIT NO. Absorption area(s DATE 72-013 (Rev. 3~78) E~LOC:I,.':.': 2 ]ii:E[. ::l..., t.3eu;::fl. [;i:.[ :.I.::.l.: :L. 25 C:l!ii:Fi'."t']: I:::'"i" 'THI::IT: ::1...:I: I:::11"1 l::'l:::ll'q:l:l....:l:l:::ll:~: I.'.I:['T'I"I THE: I:;i:[!:I:;!I.J]:I:;i:EI'"I[:~:I",F[':!!i; i:Cd:;i:"l"H EiF/ 'I"I'iE: t'ILJN :[ C: ]: F'I:::Ii.... :[ 'T"¢ Ell:::' I:::lf',lC:HOl:;;'.l:::l(:ii[ii: < I'qOFI ;' l::ll",ll'::' THIE :~i;'T'I:::ITE Ol:::' F:II....F:r.:~;I..':.'t':I. ,;::. ]; I.,.!:[L.L.:t:i'.,i:ii;TF:iL.f... TI.E: F:;'T':~-!;T[ii:i'q :[1'.,~ I:::IC:COF?.i::,FINC:E H3:"t'FI I:IL.[.. I','IEH:::I ::::::::::::::::::::: FIN[::, I::~:I:?::I.']UI._I::I'T'ION:~!',., I::'IN[::, :1: I'.,I C:Oh'IF'L.. :[ I::ll'.,E:!ii!: 14:1: TH 'T'HE [::qE::~i; ]: GI'-,i CI;..'.' :[ 'I"EEI:;'. ]: I::l O[:' TIq Z :~i; F:'[EFi:i','1:1: 'T'. ::ii:. :!: !.,.I :[ !....L. I:::![>I..I[::;Fi:[!!: 'i"Ci F:ILL.. F]OI:::I I:::lJq[::, ?I"FI'TIi:; O1:::' RLI:::I:~!;I.(FI I~'.I~:'~(;!I...IZFi'.IEi',IE:I'.JT~..; ]:::'C.)F?. THE.: ~ii;l:~]:"F EiJI:::ICI.::: f:::, :1: :!i;"J"l::lNl:::l!ii::i~; 1::'1:;i:Oi',! I:::fi",l"r' E::::.:: :1: :E',T :1: NG HEL..[ ..... HI::I:iii;T'[~:t.,.IFT'I"E:I:;i: f::, :[ :~.~;F'O:ii;F:IL. :iii;"r'?TEl'"l ' (31:;i: I::*U[i3L. :[ C :E;E::I.,.!I!!!:I:;i:I::IGli!!: '.!i;"~":!il;"l"l:!i:l'"l Ol",l TH:l::ii; OJ:;i: I::lJ",l"r' I:::I[::,..:rI::iE:E!:IqT :!: f...II'.,E:,EFi::iii;T]::ii'.,II:::, 'T'HI::IT ' l" H ]: :!i!; I:::'EI:~'.I'q:[T :[:i!i; ',,,'I::1!....]:[::, F'OI:;.'. I:::1 PtF:I::.:;]:I','II...II','I OF:' ::ii: E~E:I.;:,I:;i:OOI',I:/.:; l:::tlq[::, I:::ff.,J'.¢ I!i!:l",ll...l:::ll:;;:l:!i[ii:l"ll!ii:l'.,IT !.,.! ]: L. I .. Fi:IE~;!I..J:[I:;i:[!i: FIN SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION; 2 3 4 7 8 ~0 ~2 ~3 ~4 1~- ~? 18 2O COMMENTS IF YES, AT WRAT DEPTH? SITE PLAN WAS GROUND WATER ENCOUNTERED? O P E · , Reading Date Gross Net Depth to Net -. Time Time Water Drop PERCOLATION RATE __ (minutes/inch) TEST RUN BETWEEN ~ ,ND FT ,,,::..: CERT,F,ED DATE: 0 v o m : i : 0 0 0 0 0 0 0 0 0 0 0 : 0'4: mi co in! uo i1'-- coi ~ 0 O O O 0 0 0 O 0 0 O O 0 0 r~ Co ~J .H © Rick Mystrom, Mayor Department of Mealth and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us 343-4744 August 16, 1998 Gary W & Gail M Stadig PO Box 671612 Chugiak, Alaska 99567 i612 Subject: Lot 20 Block 2 Skyline View Subdivision Permit #SW970185, PID #051-192-97 The subject permit, issued July 11, 1997 by this office for a single family well and/or on-site wastewater system, has expired as of July 11, 1998. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. Ail inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. ,/S'~c~rely, /z~ ~es ross, P.E. P~ogram Manager On-site Services enc: Copy of Permit PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970185 DESIGN ENGINEER: OWNER NAME:STADIG GARY W & GAIL M OWNER ADDRESS:19426 WILDWOOD DR DATE ISSUED: 7/11/97 EXPIRATION DATE: 7/11/98 PARCEL ID:05119207 LEGAL DESCRIPTION: SKYLINE VIEW ELK 2 LT 20 LOT SIZE: 15408 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 A/qD THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: EXISTING WELL~ AMC 15.55. RECEIVED BY: ISSUED BY: ~LL BE DE-~ZISS. IONED ACCORDING TO DATE: DATE: i MUNICIpALiTY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEAL~! DEPARTMEN]? OF HEA[0~-I AND ENVIRONMENTAL PR(TrECTION AP,?LIC~%TIC~ FOR HE~L.TH ~.)~i%IORITY APPROVAL CERTIFICATE '% ~ ~gr~!:t'ai tr~forr~%ticr: Application Date block, subdivision, range) Ls) !regalfl~ scriptior]d :'7-'_~ ~'72_~__~- ~2~/~__. ~.~_(include lot, .~_. ~ >5~/~ ~ ~-/'-~:? se.c, tj.on ,~//d'27 ~x/t°wnship' ~mtio~u (adduess or directions) (b) (c) Applicant is (ched~ one) Lending Institution BuYer ~:.~; Other [i__q (explain); (d) Lending Institution Address Te le.p hone (e) Real Estate Coo & Agent Address Te le phone 2. ~ of N~sidence S ] ngle-Fami 'Ly~'~;~-~ ~. Number of Bedrooms 3. _Wa.tear_ Sup ~i~y. Mult i-[,'ami].y [~ Othe~ (describe) Individual Well~q_~- Co~unity C_~-~_ Public C[-~ Note: If c~,t~mnity yell system, must have. written confb:n~ntion f~,cm the State Departu~.nt of Envirommntat Conservation attesting to the legality and status. Is the v~.].l adequate for the number of bedrocn%s slmcifJ.ed in this HAA ~N) 4. ~.~Dis_p~qo~.~l~ Onsit. e.~- Public! _~__] Community [[_-~.. Holding Tank ~_~ Is the wastewate~, disposal system adequate far the numbe~ of bedro~ns~__~_)/N_) [Pag~ 1 of 2] 2-15-84 Inforr~tion En~.neerin.~[ Firm P~ov>d~i_n~__/:.n_s_pections, Tests, Data and 5o I certify that .I h~aave ~e. eked,, verified, o~r oonforrred toall MOA HAA id~l~' effect o'~ thp/~ate ~~'ctiono ~Gu Signed--7 Date ' ~' ~'~:"L ~he Municipality of Anchorage Depa~l~ue..nt of E~alth and Environmental Pr. otection does not ~]arantee the continued satisfactory performance of the watez supply and/or the wastewater disposal system. 'Ibis approval indicates that, as of ~:~ validation c~te shown above, bused on t~ data and information furnished k[f an engineer registered in the State of Alaska, the water supply and wastewate~ disposal system is safe and func~ tional for the numbe~? of bedrooms and typ~ of structure indicated. ( DftEP SEAL) Mail the HAA to the following add~ess: KB2/d5/s [Page 2 of 2] 2-15-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AU~HORITY APPROVAL (HAA) ?:i,~ OF HEAl. IH & [:h~'/ig',i~'ilv:,:NI/sl. PRO 'gC]'lOh CHECKLIST - FEBRUARY 1984 Well Classification Well Log P~esent ~/N) Total Depth Static Water Lc'vel Casing Height Above GrOUnd Electnzical Wiring in Conduit ¢~N) Separation Distances frcm Well: Cased to Date Completed Pump Set At If A, B, o~ C, D.E.C. Approved(Y/N) Depth of G~outin~. Sanitary ~al on Casing ~) ~pression ~ound ~l~ead To Septic/Holding Tank on Lot /~)~ / . ; On Adjoining Lots To Nearest Edge of Absorption Fiel¢~n Lot /~ ; On Adjoining Lots. To Nearest 'Public Sewel~ Lin~ ~///~ TO Nearest Public Sewer Cleancut/Manhole ' ,d~ ..~tl ..... .m,>TO Nealzest Sewe~ Service Line on Lot ~:) /-~ Wate~ Sample Colleet~.~d..~f~ .,., ..... ~. ,.~.~.~n ,ce~v~ , tt ~/// Water Sample Test Regults PH. 6,4~,?Yi'.3 ~'~/~ ~ ! /=-~$~__ ~:-4.~ .,~_ f,~, . SEPTIC/~Tr~N~~ TANK DATA Date Installed ~/~/~/~ Size / ~3~ No. of Compartments Standpipes ~N) Air-tight Caps./N) Foundation Cleanout ~N) Depression Over Tank (Y~_)) Date Last P ~umi0ed Pumping/Maintenance Contract on File (Y/~) A///~ ; for ' " Holding Tank H~gh-Water Ala~ (Y/N) ,////0 Te~po=a~y ~old~ng Tank Permit (Y/N)~_L Separation Distances f~om Septic/Holding Tank: To Water-Supply Well To P~operty Line To ~te~ Mai~)~vi~ Line Cour~ / To Building Foundation To Disposal Field ___~ To Stream, Pond, Lake, c~ Major D~ainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Pating in Absorp~ion~t~ata Date Installed Width of Field Length of Field Depth of Field System Design Gravel Bed Thickness (~ // Squalze Feet of Absorption A~ea ff~-~) ~ Standpipes Plresent Depression over Field' (Y~.i) / Date of last AdsquaC~; Test Results of Last Adequacy Test /~//~ Separation Distance fr°m Absorption Field: To Water-Supply Well //~ / To P~operty Line /~) / T© Building Fo~lndation ~// / To Existing or Abandoned System cn Lot ~z/~ ; On_A~joining Lots ~'L> /.-~ To Wate~ 'Main/Service Line/v//~ To Cutbank (if/present) To Stream/Pond/Lake/c~ Major Drainage Course_ To Driveway, Parking Area, o~ Vehicle Storage Area '~ Co, ments D. LIFT STATION Date Installed Size in Gallons ,,Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Connlents Dimensions Manhole/Access (Y/N) "PuraD O~f" Level at / 4/'//7 Vent (Y___~) Pump ingalls du~ing Adequacy Test. Msets MOA ** ** Check Permitted Bedrcom RatingAgainst HAA Request I certify that I have checked, verified, o~ conformmd to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~t~ 196)r,, t' ,r.,.,..~,? Company i~ y6 ~.~9 4-9.9'~ [Page 2 of 2] Date 2-15-84