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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)