HomeMy WebLinkAboutPETERS GATE BLK 1 LT 11A
/' 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 ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
IWell IAbsorptionaroa .IO Dwelling PERMITNO.
No. of compartments
~ ~ Manufacturer
Liq. capacity in gallons Inside length Width Liquid depth
J DOC, IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z < Manufacturer Materia)-- Liquid capacity in gallons
~ Well Foundation
~ · ~ No. of lines Length of each line Tota~ length of lines Trench width -- Distance between lines
~ ~ ~ Top of tile to finish grade - Material beneath 'tile Total effective absorption area
Length Width Depth PERMIT NO,
( ~ ~ype of crib Crib diameter C~e depth Total effective absorption area
~ Well ~ Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ ~ DISTANCE TO: ~uilding foundation Sewer line Septic tank Absorption area(s)
PIPE MATERIALS __
SOIL TEST RATING
INSTALLER
REMARKS
72-013 (Rev, 3/78)
( eri fieh r[lli.g
by
DOC Co.
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND F/~ ,~j ,A/~./~ c. h.t~'' DEl'TH OF WELL
ADDRESS ~0 ~0 X ~/~- ~ ~ ST.~TIC LEVEL OF W.~TER Fr. /0
LEGALDESCRI~ION ~oT/t ~ I~4~ / ~:'~'-*~~DRAWDOWNFT.
DATE-Started ~ Ended 6/',P~ ~-/ GALS. PER HR
PERMIT NUMBER ~ KIND OF'CASING
. .. ' '" ~ ~ '::~.r,::',:k." ..;2~::'~~ ' ~. :_::,: ~ ........... ~ ..... > ~-' ) :.?a:. ~:~-:
KIND OF. FORMATION':
From CO Ft. to · ZO .... Ft. 0 t. dt-~'~ ~,a~'~Z),c-~,'~J From . .Ft.
From 6 Ft. to ~ J .Ft. ~ ~~-' ~ From~Ft.
Fromm. Ft. to Ft. ~O o~ ,~'~ From ~. Ft.
From ~ Et. to C~ Ft. ~oo~ ~l~ From~Ft.
r om to/4tFt. UJ om,
From Et. to .Ft. ~4AFZ ~C~mt _ From~Ft.
to Ft.
to Ft.
From /~l Ft. to /&o Ft. ~OtTo~ From Ft. to Ft.
..... Ft. to' F~
From Ft. to Ft. From
--Ft to~~-- ~
From .Ft. to Ft. From, Ft to
From Ft. to. .Ft. From Ft. to ,.Ft.
FrOm~ ,,.Et. to Ft. From .Ft. to Ft
MISCL..INFORMATIOtN: .
DRILLER'S NAME .t~.~ ~ ':" '
BLt ~.1 ..............
MUNICIPALITY OF ANCHORAGE
Department Health and Environmental ~otection
825 ~ Street, Anchorage, AK. ~501
264-4720
* * * HANDWRITTEN PERMIT * * *
Permit ~
WELL AND/~ ON-SITE SEWER PERMIT
Location: ~F,$ ~ ~'~ ~~''~-)~--Phone~~'~Number: ~/-
Legal Description: Lot llA Block 1 Peters Gate S/D Lot Size:
Type of Soil Ab,~rption System Is: ~ ~/ '--/7..~/ ~./~L/
Trench: ~" Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is: ~
DEPTH ¢ LENGTH ~-~ GRAVEL DEPTH ~' WIDTH 3~"
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(°in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE = /(CDdO GALLONS
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may~require enla/~gement if
remodeled to include more thaJa~ bedroo~/
APplicant
Date: ~/~//(~ I/
SWP/024 (1/81)
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:
8
SLOPE
-4
DATE PERFORMED: ,JL~n~' o~. ~
!
PLAN
~'1"l"' [ 1 ~ ,,r.j' ? [9
I
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
/.- -%,
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN ., FT
B ETV~E.EN ~ FT AND ~ .
COMMENTS
PERFORMED BY: .~ ~r-~¥"~.~'~ "~-i E-~"'~ DATE:
72-008 (6,79) O~ ~ ~/~.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO'I ECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720 ~.
Application Date
1. GENERAL INFORMATION
(a)
LegalDescription(includelot, block, subdivision, section, township, range)
Lot'~lflA,Block 1, Peters Gate T15N R1W
hocation(addressordirections)
Serria Mesa Cir.
Sec. 11
(b). Applicant Name Kenneth Knecht Telephone: Home 688-5051 Business 564-8501
Applicant Address POB 770415 Eagle River AK 99577
(c) Applicant is (check one): Lending Institution [] · Owner/builder[] · Buyer [] ' Other [] (explain);
(d) Lending Institution HQm¢ S_a_v,ings and Loan Telephone __ 272-145_~
Address __~ 1~ Benson Anchorage Alaska 99508
(e) Real Estate Company and Agent _ N/A . .
Address
Telephone
(f)
Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family~ Multi-Family [] Other
Number of Bedrooms 2
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 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 PROVIDIN,. ,dSPECTIONS, TESTS, FILE SEARCH, DA.. 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, -1
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 =^m ~ ,,,,,,~,, ,.~,,,,,,,,-... .~,r. Telephone
Address EAGLE RIVER, AK 99577
/,~,/=~.~/~ .f' P, 0. BOX 773294
Date
//'- - 654-5195
DHEP APPROVAL
Approved for ~ bedrooms by~ ';'.x~
Approved /" ~ Disapprovedf Conditi~al
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 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
72-02s (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA) ~CT. ~ g I~
CHECKLIST- FEBRUARY 1984
264-4720 .~~~
Le,,~al Description: /o Z"//
WELL DATA
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~.~'///~-.5- Yield
Depth of Grouting /'//"//g
Pump Set At ,~
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
· On Adjoining Lots
; On Adjoining Lots /'P~ ~''
Well Classification
Well Log Present (Y/N)
Total Depth /~ ~ ~ Cased to z/
Static Water Level /o "2"
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
/
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole '"'~
Water Sample Collected by Z~-~._~
Water Sample Test Results
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot ':~'
~,.~,'~;¢,',?'-~ 'Date '/°,~ ~',/°~J'-
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) ,)/ Air-tight Caps (Y/N)
Depression over Tank (Y/N) ~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~::~4:~ /
To Property Line //.2 f'
To Water Main/Service Line 70 '~
Course
Size //~'° No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped '~"/~' ~'
'for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ~''
To Disposal Field ,/~ /
To Stream, Pond, Lake, or Ma~or Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ .. ~',"/¢-~-
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
To Water Main/Service Line /~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
'30 /
Length of Field
Depth of Field 7 ~ 3~
?
Gravel Bed Thickness -~-
Standpipes Present (Y/N)
Date of Last Adequacy Test
Y
To Property Line
To Existing or Abandoned System on
· On Adjoining Lots -~'
To Cutbank (if present)
+-]o /
Comments
LIFT STATION
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.
Date
MOA No.
Signed
Company ~'-,/C~'..T,
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)