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Home My WebLink AboutLAKE HILL ACRES #1 LT 36 MUNICIPALITY OF ANCHORAGE DE/~-'ffMENT OF HEALTH AND HUMAN SERV' %S / ~.' L' Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ DISTANCES ~ ~ ~CI~ ~ Tn SEPTIC ABSORPTION ~r~ ~NLH,FR0~ TANK FIELD WELL Phone(s) Permit No. No of B~oms~ WELL LEGAL DESCRIPTION Lot ~ ~ J Block Subd~vrsion AS-BUILT DIAGRAM (~how locahon of well, septic system, property lines, foundaho~, ~//~ / /~ ~ ~ ~ dnveway, waterbod~es, etc) TANKS Material NO. of Compadments ~ O J ~YPE OF SYSTEM ~RENCH ~ BED ~ W. DRAIN ~ OTHER °r'ginalgrade ~ FT J ~ F~ Fill added abo .... ig,nal grade Gravel depth benealh pipe j Gravel length Gravel w~dth Total absorphon area Distance between hnes 5~ SOFT '~ J ~ FT % Installer Date Installed WELLS ~RIVATE ~ OTHER fldentifv) O Classilicahon (A,~,C) Totm Depth Cased to REMARKS: P.O. i~'~( 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 Jeff Uhlik 4110 DeBarr Road, Space Anchorage, Alaska 99504 9B17 Subject: Lot 36 Lake Hill Acres Subdivision On-site Sewer & Well Permit 9860268 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sincerely, R.W. Robinson Program Manager On-site Services RWR/ljw enc: copy of permit APF'L. :!: CA N'i" ~ ADDRESS ~ CONTACT PHONE !....EGh!... DESCR ]: I:::' I....O'T' S :[ ZE ~ I cer. JEF;'F:' UI..]I_ :!: K 4:1. 10 DE.I'.-':~ARR RD,, SP B 17 AI',tI2HOF~:AEiI!~.:, AK 99504 3 33 ---' '79 J. 3 SUB[):I: V I S I ON: L. AKEH I EL ACRES :PI :1. LO"I': 36 F LOCK: N/A SE!:C'f'ION~ ": ....... b , '"'1''~'''. ' =" ..:. ] U>,II,!,:~I-..I.P ~ .t.,.:N RAt',IGiC~ :E'.8219 (SQ. i:::-T', OR ~.~ ,I.~[ c ) Fcm'Li] by 'Lhe I"h..~rlJ.(.]ipa].J.'~.y o~' ,Ar~choPage (MOA) and 'i:.lne State c.~' Alaska, ]: W:i.i]. :Ll"Ms'f..all 'Lhet syst(c~.m in a[:c:oPdar][:~.) wit. h all MOA codes and Pegulations~ and ].n compliance with the design c~ ].~.epia o[' Chis pE~Pmit I ~,~'J. t ]. am~e' "' ........... -~-~ 'Lo a:l. ]. MCIA and State (7~' Alaska ['.eqL~il~ements EQ[ .... ,... ~'"... set back dis'l:.ance~ [Pc:)m any ~E.x~st:i. ng we].~ ~4aste~x~ater' d:i. sposal system or' publ:[c :~'y~:~ ~,,~..:.lin u;It ~,li i E5 CIP ai]~/ c:~L.l,l ~u.~all~, iBP ]: i::: A 'T'HIiEN W ]: i....I .... Ei]....t!:~C:TF~:!:C::AL WORI< MUST BE Df:]NE BY A t_ICEi',ISED IELEC]"RIC;IAN ~ ....... h._.~ DATE APPL. I CANT ~ ,:, ~E.'rl::' ,.tHJ...~ ]. K ~ --~ /~.. ,.,0 v,:.f~ ::..U :E: Y MOA .dU :i: I...D I NEt CC)DES, I...:I:1::"1" STATtC)N IS T. NSTALLED [Ixl AN AREA r'- '~' '":'-' '~' , "~ ::~::l::'f',"~ ...... (2 ' ' ' ""' (1,' AN EL.E:CTR:i:CCAL. F'E]::;:MIT AiXl:[) ...I.I,. I .... ]ltrJ ML!ST BE OBTAINE:D~ ) Acm'I: J..L.I NOT L::',E~...d'"r'~,.C, vc.~.~"'~' ':': ~"'~ ~.['" '~"', ~'-IL,LI! ''~ .... AN E:LEC"I"R:EC'.AL ]:NSF:'EC]"]:ON !:~EPOF:,'TJl. AND (3) THE: S &..S ENGINEE~aNC. "SRB .196X 'F~GLE RIVER, A~ ~" SUBJECT: C~MPUTATION SHEET JUL 3 0 ~g,-q$ DATE: SHEET ~__~ OF ~ BY /'~/0 / CKD ./ v PERFORMED FOR: LEGAL DESCRIPTION: 2 3 4 5- 6- 7 8 10 ~2 13 14 17 2O COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORME ~ ..~ ~...~{..r.:~t~ ~'~r'~ T~/wnship, Ran§o, Soction: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT O DEPTH? p Oeplh to Waler Gross Net Depth to Net Reading Date Time Time Water Drop q [, C,,~ ~-- ., is- ~Js ,Iz~ S & S ENGINEERING SR B 196X EAGLE RIVER, AK 995~:~COLATION RATE ~-~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~**'"' FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ STATE OF ALASKA DE, ,TMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either Iat lb or lc.) A,D.L. No. la.lJBorough ~S, ubdivieion Lot Block ~b.ll I/4qtrs. Section No. To~vnshiPN[~ Range EE} Meridian Street Address end Area of Well Location ~?~ 1~'J (- ~"~ / ~'~ )~: ~ 7 ~;-'C.; ~ Feet Below 4. WELL DEPTH: (final) 5. ~TE OF COMPLETION 2. WELL LO~ Surfoce )¢-. / ~ ft.-- -- Moteriol Type Top BOttom · Commericel Set between ~t. and Sackfilling Grovel pack MUNICIPAiDEPT. I~ OF ~N( Dote ENVi~G~ ENTALOF HE~tp~*t & Equipment used: ft. after hrs. pumping ~.p.m. I~, PUMP: (if availeble) HP Length of Drop Pipe ~.¢./~) ft. capacity ,7. ,,, g.p.m. 16. WATER WELL CONTRACTOR'S CERTIFICATION: o 15. Water Temperature ~ ~ F ~ C This well was drilled under my jurisdl~tio~ o~d this report is true to the besl of my knowledge end belief; :/ Authorized Representolive Form OZ"WWR (11/81) COpy Distribution: WHITE-Stale DGGS~ PINK-Driller~ CANARY-Custome~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) LeoaI,Description (include lot, block, subdivision, section, township, range) Location (address or directions) ' (b) Applicant Name~¢'~'¢=~E:c¢~- /-~/-/~F Telephone:Home ~,~J)-O~,13' Business Applicant Address-~'(C"--~ I[~o~,.-/~J ~. (:~ .~,~("',,.¢//4.~; / /¢rZ~t ~ ¢J"-~, (c) Applicant is (check one): Lending Institution []; Owner/builder~r'; Buyer []; Other [] (explain); (d) (e) Lending Institution 4/~'~/~'~' ~' S ,/~ Address ~",¢~/~Z2/7 t',Z X.~ I o ~ ~ /'~. Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: S & S ENGINEERING Eagle River, Alaska 0~2577 TYPE OF RESIDENCE Single-Familyx Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Welt~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,~t 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 (11/84) Page 1 of 2 ENGINEERING FIRMPROVIDIN .NSPECTIONS, TESTS, FILE SEARCH, D~-. , 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 i~formation 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, ~n~ regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Address ~ ~n.~,~,...-. EcU!= ~,:.:=... L"~'~ .....~^"~ ,.~'~A, ,~n,. Date Eagle River, Alaska 99577 Telephone : DHEP APPROVAL Approved for ~-- Approved X Disapproved Conditional 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-o2s fl ~/84~ MUNICIPALITY OF ANCHORAGE (MO~,, MUNICIPALtTY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL P.OTEOTION 264-4720 9 9 1987 Legal Description: F WELL ,ATARECEIVED Well Classification Well Log Present'N) Total Depth Z../~ / Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit(tUN) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed ~-- ~-~¢' Yield /?_c~ Depth of Grouting Pump Set At /z/' ~" Sanitary Seal on Casing Depression Around Wellhead To Nearest Edge of Absorption Field on Lot ¢'¢2¢/-/- ; On Adjoining Lots To Nearest Public Sewer Line /C/OF To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments /~ / ¢' ; On Adjoining Lots / OC~ '-/ /V'/,XJ To Nearest Sewer Service Line on Lot · -~-..% 'C~-i~/~.~,~-~.=¢~-1'~ ~ ;Date // / B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes ~)'N) Air-tight Caps C/N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N)/~/~/~//-'~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line /(~/-/; To Water Main/Service J-ine Course /V//~ Size /~', 5-'0 No. of Compartments Foundation Cleanout(~2/N) Date Last Pumped ,~_~,,M,./' ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,~/-'' '/ Square Feet of Absorption Area Depression over Field (Y/(~ 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 Length of Field /'// / / Depth of Field // Gravel Bed Thickness tlT'/ Standpipes Present (~)N) Date of Last Adequacy Test / -Fo Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /'~'///~ Comments D. 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 of Payment Page 2 of 2 72-026 (11/84)