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HomeMy WebLinkAboutHENKINS BLK 1 LT 13 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION '.i ~ ENVIRONMENTAL ENGINEERING DIVISION  825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] NEW NAME t-/ar X. []..GRADE LEGAL DESCRIPTION ~ Manufacturer., ~ Materia¢.r~/ NO. of compartmentsz Liq. capacity in gallons Inside length Width Liquid depth ]¢~ ¢ IF HOMEMADE: ~ ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ Manufacturer Material Liquid capacity in gallons Q Well Foundation ~ ~ Nearest lot line ~ PERMIT NO. ~ DISTANCE TO: ~ ~ ~ No. of lines.~ Length~ ~ Trench width.~ inches Distance between~ lines -- ~ /'8.. ~ o~ea~h;ine Total length o}lines ~ Top of tile to finish grade~, Materia, o ,,~ h tile e a Total effective absorption area Length Width Depth PERMIT NO. < ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer I~ne Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS Cost SOIL TEST RATING INSTAELER Permit Applicant: MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmental~rotection 825 . . Street, Anchorage, AK. ' ~501 ~ The Required Size of the Soil Absorption System Is: DEPTH 9.o / LENGTH ~ ~ / GRAVEL DEPTH WIDTH' Location: Legal Description: ~o'T /~ ~/ Type of Soil Absorption System Is: Trench: ~/ Drainfield: Maximum Number of Bedrooms: -~ 264-4720 * * * HANDWRITTEN PERMIT * * * ~W~ ON-SITE SEWER PERMIT Mailing Address: ~. O.~D~ 7 Phone Number: ~- ~7'~ ~/~//~Yx~/~ Lot. Size: ~ ~ Seepage Bed: __Holding Tank: 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 ~ipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /6~ 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 enlargement if the residence is remodeled to include more that 3 bedrooms. S igne~: ~/~ ~ ~'~<~----~'~ < Issued by: ~.~o~<,.__.,,~, ~ Applicant Date: ~ c/~ ~ ~ ~ O & E ENG.NEERING & DEVELO, MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: SOIL LOG Mailing Address: /~' ~'~' ~:)6 )~ -~ ~/ Earl Ellis 688-2280 Legal Description: Depth (feet) 0 Soil Characteristics 10__ 11__ 12__ 13__ 14__ 15__ 16__ PLOT PLAN Ground Water Encountered: Yes.__ No ~ If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: A//~ /~r)/_~/~_ ,~I,~Od/~T/~-&-ZP _~ PERC. TEST · ~% Earl P. Elhs · ~ Performed by: January 4, 1978 Harry Mules Box 197 Eagle River~ Alaska 99577 Subject: Lot~L2~Block 1 Henkins Subdivision Pem~it ~770977 A permit issued by this department for well and/or sewer system has expired° Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance° If you have drilled the well, a well log should be sent to this department to doc~uent the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer ~%d Water Section M:i:NZMLIM D]:STF:INCE DE'T'WliEEI'q R WELL. FIND FtN"r' 1:3i",t'~"SiTE E;Ei.,.1FtGE Di:::'i;POSI:::tI.... :~;'-¢STEM .T.:E; :LOO FEE'I" i=EIF.?. I=I PP.i',,,'F'ITE i-,.IELL. OR ;200 F=EET FOR I:'~ PLiE&..IC WELL. WE:]...L LOGS FIRE F.:ELT.!LJ'.[rRE[> FIN[:, i"IU?T' BE RETURNE[:' TO "FHE DEPFIR"FMENT OF THE WEL, L COMPL. ETZON, OTHER RE(;'~U :1: RENENTE; MFI"r' FIF'PL"¢. SPEC I F' I CFIT I ON2'; FIN[:' CONSTRLiI::"F .I: ON [:' .1.' Flt]il:;;:FtFi::F; I=!RE R',,"I=I t L..t:':IBL. E TO I i'4SUF.:E F'I:;;:EIPER :i: N:"!;i"I:::tLI_FFf' I EIN_ :i; ..:J: t 1.1- r 't"HR'T' ::L: t RI'"i i::'FIM]LZFiR I.,.l'J;]".i--I THE REQU;i:REf"IENTS FOF.: ON-SiTE :.:,;EI.,.IEI:;i::E; FIND .P4EL, I...tE; F'I:!!.:; :=-.';E"i~ F:'ORT.H E¢.¢ THE M. t'.l ,i: ': I PRL. :[ 't""r' OF FiN ;7: Z i.,.ItLL ]:N'."~;'~-I~....L. THE %"r'~i;"i"Ei'"i :i:N FICE:Ed:;.'.[:'RI",ICE 14ZTH THE '=" '"' ': '" "~~x-':T-'-~.x;~.-:q:;:;.-;~"'v-:F~,.,_ ,,,.,,,:,.,.,, ,_.,...~.. =. by A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE694-2588 OWNER OF LAND ADDRESS DATE-Started Ended / PERMIT NUMBER '] 7 ~) c/~] 7 DEPTH OF WELL STATIC LEVEL OF WATER DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From C) Ft. to ~ From ~ Ft. to. From o Ft, to 74 From / '~ Ft, to ~'~) From ~Z') Ft, to ~:/<~ Ft. From '~'q' Ft, to Ft From Ft, t~ Ft, From Ft, to.__.Ft From Et, to. Ft From Ft, to.__.Ft From Ft, to Et, From Ft. to Ft, From Ft, to Et, From. Ft, to Ft, From__Ft, to_ Ft. From__Ft, to .Ft, From Et. to Ft, Ft. Oct~,~ ~0,4/3~ao From. Ft. to Ft. __Ft ~6eq~' ~- ~r~ ~ From__Ft. to Ft. . Ft.~O ~t ~ (~ From Ft. to Ft. Ft. 3/}% 0 ~4~0~ ~O~7~'~From Ft to Ft, ~z~O~o< /~ From__.Ft. to Ft, From Ft, to Ft, Fromm. Ft. to Ft, From__.Ft. to Ft From Ft, to Ft From-- Ft, to Ft From Ft. to Ft From Ft. to Ft From__Ft, to Ft From Ft, to__ Ft, From~Ft, to__ Ft, From Ft, to Ft MISCL. INFORMATION: 0(7 "~ O0. O0 ' ,:) ,9 EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PROPOSI~D CONSTRUCTION PLAN I hereby certify that I have surveyed the following described property: LOT- I~: i~_LJ~ II Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach ¢": t~e property lying adjacent thereto, that no improvements on prop- erty lying adjacent thereto encroach on the premises in question and that there are no roadwa>s transmission lines or other visible easements on said ~operty except as indicated hereon. Dated at Anchorage, Alaska FRED WALATKA & ASSOCIATES Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Henkins '= DEPARTMENT OF HEALTH & HUM/ Division of Environmental . .,. ,: ,;, On-Site Service,~ ,.. . . ~- p,O, Box 196650 Anchorage :" .. ~., , ~. . 343-4744 CERTIFICATE OF HEALTHAUTHORI!¥.: ' ': ~ APPROVAL FORASINGLE · , . '~ :L~ '~ ~.'~ (~j~Z-~ ..~ ,.~Ot~ _ ;~),OI .~:, ~i.."HA'A'. Lot 13, Block-1 Location (site add~ess or directions) 16038 Division Street, Chugiak Property owner Mailing address Lending agency .~;/A Mailing address M~I],~ c/o Brad Mills ~ Day phone 694-5964 Eagle River; AK" 99577 Day phone Agent Address N/A 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- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site · Holding tank .:,..' _ Community on-site Publi Sewer '" NOTE: If community wastewater system, proWde!Wdden'confirmat on from attesting to the 'legality and status J STATEMENT OF INSPECT, ION/BY,ENGINEER As certified by my seal affix,,ed heretQ.and as of the validation date shown be ow verify that my investigation of this Health~,A~th~,ii~!Approval app cat on shows that the on-s te water su . .~' ' .' ,-:c' ~i' ~.,~;-~,'. . PP Y and/or wastewater dlsposa! Syste/fi ~s safe, functional and adequate for the number of bedrooms · and type of structu re indicb, te( 'the Munici a,ty of Anchi' ?G h'.' supply and/or wastewate~'dls ordinances, and regulatlb~Sl'r Name of Firm 'Rag'le R'iV~ ~ Address er~'i'l~l;~ ~-t,~ I,,further. verify that based, on the information' obtmned' from ues'.'¢~d from my invest gafion and nspect on the on-s te water ~:'~ :,~ ,.¢i~ '. r ' . , sa[system is in compliance with all Municipal and State codes, ffect 'on the date of this inspection,, '-..? ':.i~ ' [ ~glneerJ_qg Services . .... 'Phone 694-5195 Engineer's signature Approved for :bedrooms. ,-,, ~,~ ur"'sa~rove'-'. ' · '" Conditional approval ior Date /./.:~ -,,-, / ~, ¢ bedrooms, with the following stipulations: Additional Comments '..-....~ ... ThC..MuCflol rage DePartment 0f Health and Human Services (DHHS) Issues Health Authority :-' ./...."ApprovaI.O6rtifi'ba~[es based only upon"the:rePresentations given n ara ra h'5 above b a ~ / .... : ~, .: . . , ..... P g P y n independent * ~, ~'/Pl'.0fflssu°P'~l'eng~neer registered ~n the State of Alaska The DHHS does th s as '~,,_L'.,,~ ,', ~,; ....... ,,.:;~, .,...., : . acourtesytopurchasersofhomes u~g.mcjr,~ena~ng msmuuons ~n orae(toi~,~,t~l,S~/,9~.e.,~ai ,rt federal and state requ rements. Emp oyees of DHHS do not conduct Inspections or analYze:~;;!~f6r~!~':!~;~ f cate s ssued The Mun c a ty of A c g ' t -. ..... ,. ~',i,,:~,~'~:,:,.,;,,.. P n hora e IS no responmble rot errors or omissions-in the Professl0nal engineer's work Legal Description: A. WELL DATA Well type Log present (Y/N) Total depth Sanita~ seal (Y~) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501. (907) 343-4744 Health Authority Approval Checklist If A, B. or C, attach ADEC letter. ADEC water system number Date completed q, /'(2,/7 7 Cased to ~'~ Casing height (above ground) /-/1~4 Wires properly protected (Y/N) /V~ FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~- Nitrate ~'~,3 ////&./Z-- Other bacteria Date of sample: gg/,,~ ~'/~;/-F Collected by: B. SEPTIC/It.O~iNG TANK DATA Date installed 0~,/~?/'¢ Tank size /~0 0 Foundation cleanout (Y/N) Y~ Depression (Y/N) Date of Pumping I/:a ,-/lq ¢ Pumper Number of Compartments ~-~ Cleanouts (Y/N) High water alarm (Y/N) Fluid depth in absorption field before test (in.):4 dry Fhfid depth (~) (ins.) Minutes later: / g6 Peroxide treatment (past 12 months) (Y/N) /.,///z) hmnediately alter t/ifa gal. water added (in.): Absorption rate = e q¢o .g.p.d. If yes, give date /? C. ABSORPTION FIELD DATA Date installed /'?~/3~ Soil rating (g.p.d./ft2 orTt~odrm) J ~7.~Z~ SysteIn ~e LenVh ~ ~ Width ~ ~ n ~. / y/ Gravel thickness below pipe Total depth Effective abso~tion area ~ ~ Mo~toring Tube present(Y~ ~ Depression over field (Y~) ~ Date of adequacy test ~/,//'3/p Z~ Results ¢ass~ail) ~ff~ For ~ bedrooms D. LIIWF STATION /A////~ Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size m gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic/lmldmg ta]~ on lot /-' Absorption field on lot 7~-/t90 / Public sewer lnain Sewer/septic service line ; On adjacent lots -/-/oo/ · On adjacent lots ~/°"/ Public sewer manhole/cleanout Lift station "Pump off' level at* Rev. 8/95 OSS: baa.wk.doc F. ENGINEER'S CERTIFICATION 1 certifv that I have determined thrufield inspections and review of]v/unicipal recordg~Thdt [h~' abb:u~ sv~t&q~s are in con/brntance with MOA H~ guidelines in effect on this date. r~; ,'q~" c4 ;. ¢% ',~::. 7 ,. Slgll,lture~~ Eugmeer s Name ............................................................................................................. '5~ec _:C02=~& 2~: ......... HAAFee $ =~ t ~ Waiver Fees Date of Paynlent /-- 2q--~{ Date of Paynlent Receipt Nnmb~r / C/.~ ~ >7~ Receipt Number Water maiWservice line ,~, o ~ Driveway, parking/vehicle storage area ___ Wells on adjacent lots ~- /o,, ' Property line Baildirtg foundation '7~/~ ' Surface water 'P / OD / Cartain drain /,,'/,4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: SEPARATION DISTANCES FROM SEPTIC/H~-I~NG TANK ON LOT TO: Building foundatiou ~ t ~ Property line 7L .~ 0 Absorption field Water main/service line Y'/,; Snrface water/drainage ~/~) ~ Wells on adjacent lots 15:54 C-~.~.ERCIAL TESTING -* m, CT&E Environmental Services inc. Labor~tory Division ~T~ ~,f., ,~.o~59-~ Laboratory Analysis Report Clien~ Sa~le ID L/~ BLK1 ~kNF~TNS UA woRK order 206~1 ~eceivedDaC~ 01/1~/96 % 1~:45 Technical Director STEPHEN C- ~DE sample Remarks: ~/~pLE COL~LEci~D BY: d.W, ~de~ed=~, Eepor~ed ~lue ie ~ D~ac~l~l ~ntlficatio~ 1~ W. Po~er Or,e, A~e;~e. AK 99518-16~ -- Tel: (9~ 562-2343 F~: [~7} 561-~01 E~IRONMENT~ FACialS IH ALA~, ~U~RNIA, ~OR~A, I~IN~S, MARY~D, MIC~N. MISSO~I, NEW JE~Y. ~lO. W~ VIRGINIA ~ I I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONI.[ENTAL HEALTH APPLICATION FOR HEALTH ALrrHORITY APPROVAL CERTIFICATE Application Date /O/~-/~zb 1. General Information (a) Legal Description (include lot, block, st[bdivision, section, township, range) Location (addres. s or directions) (b) Applicants Name~//.i~? Applicants Address /~L~ I.~.~, (c) Applicant is (check one) Lending Institution Buyer ~ ; Other ~ (explain); (d) Lending Institution Telephone - HomebC'','r'' 2f~u~Jsiness .5 ,'~'/0 ~- ~---~ ; Owner/builder~ ; Telephone (e) Real Estate Co. & Agent Address (f) Telephone Mail the IIAA to the following address: f /:. ..~~7 o "5 '7 7" 2. T_~e of Residence Single-Family.' Number of Bedrooms 3. Water Supply Multi-Family~ Other (describe) co.: ? . .--', Note: If community well system, must have written conzrrmat~on rrom~ne 8tane ' Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public ~-~ Community ~--7 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] DHEP App{oval Approved for ~5~bedrooms Approved~__ Disapproved 5. Engineering Firm Providing Inspections, Tests, Fi_le Search~ Data 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 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 regula- tions in effect on the date of this inspection. Name of Firm .A~-/~._~.;~_~O ~"~f_ Telephone ,~ z{~_ ~ 7/! ~.%.% c:-~ao9 .' O-~ By ~ ~2': ~ Date Conditional Terms of Conditional Approval CAUTION THE ~U~;ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGIb~EER REGISTERED iN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCI{%SERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ae Be WELL DATA Well Classification Well Log t~esent (Y/N) MUN$CIPAI.ITY O~: ANCHORAG~ DEPT, OF HEALTH & ENVIRONME~NTAL P;IOTEC'EION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: ' ' ~/'~ If A, B, or C, D.E.C. Approved(Y/N) Date Completed 10 '-1 ~- 7 7 Yield Total Depth .~ Cased to Static Water Level _6~' Casing Height Above Ground ~ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Pump Set At Y Depth of Grouting. Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /~D ,~- To k%arest Edge of Absorption Field on Lot /~/.i-~ ; On Adjoining Lots To Nearest Public Sewer Line ~/ f~ To Nearest Public Sewer Cleancut/Manhole /%7//~ To Nearest Sewer Service Line on Lot ;~ Date Installed ~//~_~/~/~ Size /0//0~.~ NO. of Compartments Standpi~s (Y~) ~ Air-tight Caps (Y~) ~ Foundation Cleanout (Y~) ~pression ove~ Ta~ (Y~) ~ Date ~st P~d /~ P~ing~aintenan~ Con~act on File (Y~) ~./~ ; for Holding Ta~ High-Water Ala~ (Y~) ~//~ Te~rary Holding Tank Permit (Y~)/~//~ Sep~ation Distan~s ~ ~ptic~otding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ;3o 4-- To Building Foundation To DispoSal Field To Stream, Pond, Lake, or Major Drainage Con~ents [Page 1 of 2] Receipt ~ Date Paid: Amount: L~f%~ 2-15-84 C. ABSORFI'ION FIELD DATA Soils t~ating in Absorption Strata Date Installed /~ /~,~ /~- Width of Field /-~;-~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~'-3z ! Depth of Field Gravel Bed Thickness 3- Standpipes P~esent (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~/~ ' ~'~' To P~operty Line //. To Building Foundation 2m~ To Existing or Abandoned System ; not /~.~ /~(.~ ~ ; On Adjoining Lots To Water Main/Service Line .~3 .¢ To Cutbank( if present) To Stream/Pond/Lake/or Major Drainage Course .A//~ To Driveway, Parking Area, or Vehicle Storaoe Area ~ .% Comments De 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 Comnents ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA ~ideline. s in effect on the date of this_ir~pection. Signed Date /~/,~ ,~ ~ ~ × , J~..% ~ · ...... '~ 'c~.. % Cc. 436? ~ e,~,~? .~'~ 2-15-84