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Home My WebLink AboutMCKINLEY VIEW ESTATES BLK 3 LT 9 NAME IVIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAE PROTECTION ENVIRONIVIENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SFFE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 9 ,~P,h~ MAILING ADDRESS LOCATION [~1. NEW [] UPGRADE DISTANCE TO: I Well _ Manufacturer apacity ~n gallons ~ IF HOMEMADE DISTANCE TO: ~Weli iWell Length of each line NC. OF BEDROOMS ] Dwelling .~' i -~NO. Material No, of compartments Inside length ~Wid~ Liquid depth Dwelling PERMIT NO. Manufacturer Liquid capacitv in gallons Foundation PERMIT NO. DISTANCE TO: No. of lines Distance between lines Absorption area Total length of lines Material beneath tile Depth Material Nearest lot line Trench wictt h '~(~ inches Total effective absorption area Top of tile to [inish grade~ ~ Length Width Type of crib Crib diameter Well DISTANCE TO: Class Depth Building foundation PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest Io[ line Driller Distance to tot line Sewer line Septic tank DISTANCE TO: NO. Ab~soT~ion area(s} OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL PERMIT biO. DEPARTMEI'.,tT C HEAL. TH AND ENVIRONMENTFIL ~ ..)TECTION 8;:25 -" L" S"['REIET. FINCHC~RF:IGE. FlK. o rt..,,] ..... ::~s; ill T tEE :2Z~; E ~.4 E ~: F" E R :i'-'if :~:: '"':i .... 830058 ) '?":' ',/M FlPPL. I C F:It",IT L. OCF:tT i ON LEGF&. STE'v'EN SKFlGGS CONST PO BOX [) CHUGIFIK 99567 L:::;O 1[ L FP,,'ERFIC:iE L9 Bi:i: PICKtNLE"," VIEt.,.I ES'TFITES LOT SIZE 999999 SQLtFIRE FEET.' T'¢PE OF SOIL. FIBSORP'I"ION SYSTEM IS: TRENCH MFlXIMUM t'.,IUM[3ER OF Ei:EDROOMS = SOIL RFITIt",IG (SC! FT.'/'BR)= 98 THE REQt.tIRED SIZE OF THE SOIL FIB'S;ORPTION S"r'STEM I:.S: "['HE LENGTH DIMENSION IS THE L. ENGTH (IN FEET) OF THE TRENCPI OR DRRINFIELD. T.'HE [)EPTH OF' Ft 'TRENCH OR PIT :tis THE DIS"f'FiNC:E BETWEEN THE: SLIRFFICIE OF' THE C. iF.'.OUN[:, Flt",tD THE BOTTOM OF' ]"HE EXCR',,,'FtTION ':.'IN FEET). THERE tS NO SET.' I,.IiDTH FOR TRENCHES. THE GF::R',,.'EL DEPTH I:!T, THE M!N!!dUM DEPTH OF GRFlVEL 8ETI.4EEN THE C)UTF'FIL. L. PIPE:. FiND THE BOTTOM OF THE E'XCFiVRTiON ,::IN FEET). PERMIT FIPi::'L I CRNT HFIS "['HE RESPONSIE:IL.t"i'~¢ ]"0 INFORM THI:F~ DEPFlRTMENT DURING THE i t'.,t:STFILLFiTI'ON ;[I",iSPECTIONS OF F:iN'¢ HEL. LS FIDJ?iCENT TO THIS PROPERTY FIND, THE: t",IUI"IE:ER OF RESIDENCES.; THFIT THE HELL HILl... SERVE. BFICI<F'iL. LtNEi OF Flt'.,t'¢ S'¢STEM 1.41THOUT FZNFIL INSPEC:TtON FIND FIPPRO',,,'FIL. E','T' THIS i},EiZ'ARTMENT t4IL..L. BE: SUBJECI" 'TO F:'ROSEC:UTION. MIt'-,tlMUM DIS'TFiNCE BETHEEN Fl HELL. FiND FlN"r' ON-SITE SEI.,IFtGE DISPOSFiL. S'¢ST.'EM :!.00 FEET FOR Fl PF.:I',,,'FiTE HEL. L OR ±50 T.'O 200 FEET FROM Fl PUBLIC t.4EL. L [:,EPEI'-.I['.,ING II.fPON THE T'¢PE OF PLIBLZE: M]:NIMUM DISTRNCE FF.'.'OM Fl PRI',,,'FITE HELL 'f'O Fl PRIVFITE S:,EP.IER L. INE IS 25 FEET FIND ]"0 Fl C:OMf'1UNIT'¢ SENER LINE IS 7'5 FEET. OTHER REQUIREMENTS f"lR"r' RPPL..'¢. SPECZFICFITIONS RND' C:ONSTRUC:TIEd",I [:,tFIGRFIMS FIRE F:IVFIILFIBLE TO INSURE PROF'ER I'NSTFILLFIT ION. I CEiR]"I F:'"r' THFi'f' :.L: :ii FlM FF::tMILZRR HI'TH THE REQUIREMENTS FOE;.'. OIq-SITE SEHERS FINE." HEL. L.:.S FiE: SET FORTH BY THE I'"IUNICIPFIL.]:]"¢ OF F:INC:HORFIGE. 2: I [,.I]:LL. ~STFILL. TI-'It;~; ?,'¢STEM Il",! FiC:E:EIR[:'FIN?E i4ITH iI?'fE C:ODES. 3: I LtN[:'Ei:~fS'I:IFtt',I[:' THFI'T ,A"HE,-~ON-S I TE 'S;E!,.IER S T'STEM MFI~' F::EC!U I RE ENLflRGEMEI",IT I F THE t:~:ESI[:,Ef,tCE/I~"/"'"* I:;;:EI"lO[:'EL~¢' /Q//,.~t,tCLUDE MORE THFIN 3 E:E[:'ROOMS. / l///[/;Z/ - .::, ~..~r,~:.~. , ~.~,~.,.::,-: .............. ~.,~._,¢..w.....~.,,=:_,~/~'~%~-L - FIF'F'I,_ i C:FII'-,FF S;TEVEN :i~:!~Gli.S'S C:ON3T ,4/ ./, Russell Oyster 694-2774 O & E ENG,.~EERING & DEVELOF Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 .,/I ENT CO. SOIL LOG Performedfor: Name: C/j/~/~ ~. ~/~/¢'~ /.~/~'~::_g.(;.,~/~2~'~ Tel. No Mailing Address: ~ _ ~1 Legal Description: ~ d/~ ~c'~ Earl Ellis 688-2280 Depth (feet) 0 1 Soil Characteristics 8 9__ 11__ 12__ 13__ 14 15__ PLOT PLAN PERC. TEST 16m Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~ If yes, what depth Drain Field Date: APPL~ ~,NT F~LLS OUT UPPER H/ ~ ONLY Property Owner !'~ ~ : L ,'~ i~ l~' u~is% / ~iiq: , ~ t }~p , ~isl~,; ~ p/? /9, Phone Mailing Addre~ j,.:~ '~ ~'~ I~ , ~;,2 ':~t,., /',Z~(://~' ~,'~c ~ ~:?: Lending Phone Realty Co. & Agent ~. , t,' ~:: r ,' Address Type of Resi~nce ~' Single Family ,3? ~ Multiple Family No. of Bedrooms .... ~ Other Water Supply ~ Individual A~ACH WELL LOG. A well 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 .~ Individual Year Individual In'tailed: ~ Public Utility When C~Rnected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Dater~ ¢ Inspector Inspector Inspector Inspector ~:/'~. MAY 2 0 1983 i ") ,,," el Hr:S:,h ( ~¢)¢~SpROVED BEDROOMS~.~ *CONDITIONS OF APPROVAL ( } DISAPPROVED ( ) CONDITIONAL APP~OVAt¢ BY: Soils Rating Date Sewer,~ F~los~talled Well To Absorption Area Well Log Received 72-023 {3/82) 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 9; Block 3; McKinley View Estates Location (site address or directions) 21413 Baron Chugiak, AK Property owner Mailing address Dawn & Chris Thayse Day phone 688-5940 P.O. Box 672038 Chuqiak, AK 99567 Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water 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 NOTE: Public sewer 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 5. 6. 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 Address Fngineer's signature S & S ENGINEERING lZ034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Phone Date II /~ 5,' ¢'/~ S~ DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date .... The Municipality of Anchorage Department 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. (Rev, 1/91) Back MOA ~Y21 Legal Description: A. WELL DATA Well ffpe Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Coliform ~ ~nple: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES~ ... Environmental Services D~ws~on 47Vk, '%L/- 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) Health Authority Approval Checklist If A, B. or C, attach ADEC letter. ADEC water system number 7-- I c> 60 q'7 Date completed Cased to Casing height (abov Wires prop~;m~r6cted (Y/N) FROM WELL LOG ~~ AT INSPECTION ~ g.p.m, g.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~1~ I~ ~3'g, Foundation cleanout (~TN) Date of Pumping Tank size to~r.:,~ Number of Compartments 'Z- Cleanouts~i:N) ~ X Depression (Y/~ ,.,1 High water alarm (Y/~ ,,5( ~\rq~qg Pumper --~,¢~ (2~p,~q C. ABSORPTION FIELD DATA Date installed ¢-~\ ~ ~q ~ Length TAct ' Width Effective absorption area Date of adequacy test / [ Gravel thickness below pipe Monitoring Tube present~a~N) k/ ResultsgC[~Fail) /9P65 Fluid depth in absorption field before test (in.); (.90 ~ Immediately after,5~'~o gal. water added (iv.): __ Fhdd depth 6efo" (ins.) Minutes later: ~0 Absorption rate ~//~--D = g.p.d. Peroxide treatmeut (past 12 months)(h(~ ~/o~ /,;,v~/¢ Ifyes, give date Soil rating (g.p.d./ft: or fl2/bdrm) 9'~ ~/~/-- System type '77/--~-,--/g-/4 C.o' Total depth I o ~ Depression over field (Y~}) ~ For ~ bedrooms 7,0 '/ D. LII;T STATION Date installed Size in gallons Manhole/Acccss (Y/N) ~ligh water alarm level al* "Pump on' level al* IlL SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tauk on lot Absorption lield on 1o! ~/~ Public scwcr main Sewer/septic sc~icc linc /4- : On adjacent lots : On adjaccnl lots Public scwcr manholc/clcauout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building fmmdation ;:C Property linc \ c3 x ¥ Absm'ption field Wah:r main/service line / o Surface water/drainage /o o Wells on adjacent lots oo / SEF'ARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Buikling £oundalion Surlhce water Cultaill drain Water maiiffservicc linc ....... &k~ Driveway, parking/vehicle storage area ~o Wells on adjaccnl lots ,:,2o o ~ 4~ Property linc F. ENGINEER'S CERTIFICATION ] certiiP that 1 have determined thru field inspections arm review of Municipal recordx / HAA F'co $ ~ (rtl (? "~ Waiver Fee $ Date of Payment Receipt Numbcr MUNICIPALITY OF ANCHORAGE ,~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Lot 9, Block 3, McKinley View Estates CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Location (address or directions) NHN Baron Drive (b) Property owner A.H~F.C. Mailing Address 451222 520 g. (c) Lending Institution Mailing Address 34th, Telephone:(home) Anchorage, Ak. Telephone Business (d) Real Estate Company and Agent ~qc,./Ma~ ¢~f R~g]~ Riw=r- Don M~f4c,nzi~ Address 1g~nn Cent¢~¢4¢]~ ~r. ~?R1 R~gl¢ R4ve~: A]~_ 99577 Telephone 694-4200 (e) Mail the HAA to the following address: (or check here,~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle Ri,vet Loep Read No. 204 Eagle River, Alaska TYPE OF RESIDENCE Number of bedrooms Single-Family [~ WATER SUPPLY Individual Well [] Community~ Public [] Public Water System ~210697 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site E~ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFC)RMATION As certified by my seal affixed hereto and as of the validation date shown below, l 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. [ 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone_ S & S ENGINEERING Address 1703~LE~gle Ri~er Loop Road No. 2o-~ Eagle River, Ala.ka 99577 Date 6. DHH8 APPROVAL Approved for ,~' Approved. bedrooms by_ ,,a_~L/~/_ '~~~ Disapproved. Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerifica[ed 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 DHHSdo not conduct inspections or analyze data beforeacertificateisissued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. '//88) 13ack Page 2 of 2 To Water-Supply Well TOLotBUilding Fou n d a~o~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course '~, To Driveway, Parking Area, or Vehicle Storage Area C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata '¢~ ~:~ ~/,ecz~ Type of System Design Date Installed '2~-/~-~'°2 Length of Field Width of Field ~ Depth of Field ~,~ ~E~G~,~el Bed Thickness (¢~ ~ Square Feet of Absortion Area ~ Statndpipes Present CN) Depression over Field (Yc~P -r~-% Date of Last Adequacy Test Results of Last Adequacy Test ~/'~,,-~-~. ~'~¢~ ~ "~ ~ SEPARATION DISTANCE FROM ABSORPTION FIELD: 'Z-~:;;~;;~tJ¢ To Property Line ~,,c~ To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutback (if present) Comments D. LIFT STATION .Date Installed "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~'~'~'~'"---~ Pumping Cycles during Adequacy Test. **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. Signed $ & S ]ENGINEERING 17034 F_agte ~er ~,¢,,~, Company ,__~. ~,,,r. Alaska 9~577 Date MOA NO. ,~'~" ~¢ ~; ;¢ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 A. WELIL IPATA Well C;lassificatien Well Log Present (Y/N) 'MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 Date Completed Legal Description: ~,~-r~'l ~'1~_ ¢-*L-~-[~- If A, B, C, D.E.C. Appr'ovedF~) _y Yield _ . Fc)tal Depth .Cased to ..... Depth of Grouting Static Water Level Pump Set At C, asin9 Height Above Ground Sanitary Seal on Casing (Y/N) ........... Flectrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SFPARATtON DISTANCES FROM WELL: Fo Septic/Holding Tank on Lot .... Te New, rest Edge of Absorption Field on Lot ; On Adjoining Lots ; On Adjoining Lots To Noarest Public Sewer Line ............ To Nearest Public Sewer Cleanout/Manhole "i'o Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample?-est Results I~,. Si!!PTIC/HOLEHNG TANK DATA Date Installed ~-~l~t~¢.~'~ S~ze Standpipes((~-TN) y Air-tight Caps ~N) Depression over Tank (Y~t~ r Pumping/Maintenance Contact on File (_Y_% HoMing Tank t4igh-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOL-DING TANK: To Water.-Supply Well 'to Property Line To Wator Main/Service Line _~ ~ To Stream, Pond, Lake or Major Drainage Course Corn ments ----I.- ......... ~ ¢ - No. of Compartments y Foundation Clean out(!~__./~) '--/ /~D~te Last Pumped ~ .... ~,-/_;z;~, ~ ; for ~ Temporary Holding Tank Permit (Y/N) /"~/,'~ To Building Foundation To Disposal Field 72.026 ([I,~v //88) Front Page 1 of 2 ANCHOR~6E/UESTERN DISTRICT OFF~.CE STREET, SUITE 13S4 ANCHORA6E, ALASKA 99503 STEVE COWPER, GOVERNOR J-"H~' O: 21-0697 To Llhoro ~t May {:nncet-n: Accor"dSr,~ to t' -~ ,~. necor-ds on ~ttle .v..~BU._._E.$~iOZF_~E.S. Uater' System lc-, in Alaska Bninkin9 ~Jater' Regu'lations~ .~.n this cornp 1 ~ance ~ith the State 06 rIPL: pkk APPL ¢ NT FILLS OUT UPPER HAl- ONLY Property Owner ~"~ ~ ",;' ~ / ? /~..'~ .. ./ .¢ -,% , , ~ ., , ~ Phone Mailing Addre~ td'.~'w ' ~ ' ~ . ~,~ Zip Code Buyer Address Zip Code Lending tnstitulion Phone Address Zip Code ~eally Co. ~ Agent Phone Address Zip Code Legal Description Street Locati~ ~-~> Type ~Residence ~Single Family : Multiple Family No. of Bedroo~ .. : Other Water Su~ : ~idual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ',~:Community For wells drilled prior to that date, give well depth (attach log if available). : Public Utility ~?~dividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ 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 Field Notes: ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL (~..) DISAPPROVED ( ) CONDITIONAL APPROVAL BY: Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~t?' :. ~ - > 72-023,