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HomeMy WebLinkAboutBRUIN PARK BLK 4 LT 16III- qO  MUNICIPALITY OF ANCHORAGE 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 ~ ~ DISTANCE TO: /~/~ ~ Z Manufacturer Material No. of compartments Liq. c~pacity in gallons Inside length Width Liquid depth ' /~ ~ IF HOMEMADE:  ~ Well Dwellin~ PERMIT NO. DISTANCE TO: BZ ~ Well Foundation Nearest lot line PERMIT NO. ~ ~ D~STA~CE TO: /~~ /~ /~ ~ ~ Z No. of lines/ Leng,~ach line Total ~h o~li~es Trench width~ Distance between lines ~m/ ~ ~ ~ ~ inches ~ ~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area ~ ~ ~ g~" inches Length Width Depth PERMIT NO. < ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING ~,~,~ J REMARKS 72-013 (Rev. 3~78) DEPF'IRT~_.I, EL!T C' HEAL_TH AND EN","IRONMENT~L i .~:E-:Tii"Tf~i HFFLI..MNT [:'RNIEL MORGAN Sk'.A E,O,:':, ~."9"-M LOCATION F'¢~LRR :.',RIVE -~ LEGAL LOT ~.6 BLK '4 BRLIIN PAR. K L],.."D LUT=,'-IZE 19000 SQURRE~-FEr. ZE]~ ' '"'-I ' "' ~ "-- '-- ' ' i'"' TYF'E rlF SOIL RE,=.ERFTION _T=,TEM I:, TF..EN_.H . , . ,. _,,_ ._ ,_. /'-""-/ MA,:':,IJ'tI.IJ'"J NUMBER OF BEE:'RUUH--, = "1. ",UIL RHTIN', (SL.-.! FT,.'BF,..,- "I._,E'~/ ...... '- -" "=- ' ' IS' THE F.'E¢.,IIIRED :,Iv.E OF THE SOIL AB_,URFTION SYSTEM [:,EF"r,= ::L2 L EI"-.IL~ TH= 4~--~--- 113 R R,...' E L / . THE LENGTH DIi'IEN_,ION I:, THE LENGTH (IN FEET:, OF THE TRENCH OR DF.'.AIN THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETI.4EEN THE SUF..FACE 3REUND AND THE E:OTTOM OF THE E:..:F:A',,,'ATION (IN FEET::,. TFIERE IS NO SET WIDTH FOR TRENCFIES. / THE GRR',,,'EL. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OIJTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET.'.',. 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. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION Rt',ID RPPF-'.OVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM [:,ISTRNCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS .t00 FEET FOR R PRIVATE WELL OR t50 TO 2R0 FEET FROM A PUBLIC I.,.IELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIML.IM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHE'R REQUIREMENTS MAY APPLY. SPECIFICRTIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"E: .F-."t".I I T E,":..,;F' I F-:ES C, EC:Ef-IE:EE: Z-..1.. I CERTIFY THAT :t.: I RM FRMILIRR I,.IITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF FINCHORAGE. 2: I WILL. INSTALL THE SYSTEM IN ACCORDRNCE WITH THE CODES. _-'::~ I UNDERSTAN[:, THRT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE / EESI[.ENCE I:, REMO[:,ELED TO INCLLIDE MJEE THAN 4 E:EE:,ROOMS. , ,~ /~// RF'PLICRNT DANIEL MORGAN ~t ~/~f - V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~.EGA. DESC.,P'r,ON= L.. I ~' ~ ~ _,.,s- - l& 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 June I]~ SOl LS LOG SLOPE WASG.O,.DWATE. fit) ENCOUNTERED? O P E IF YES, AT WHAT OEPTH? [] PERCOLATION TEST Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN , FT AND FT · DATE: ~/~'/~/ 72-008 (6/79) / a Oct•II. 2006 10:45AM Garness Ensineerins Group, Ltd. ACTURM TOt 01.41m OC c@eleplui and C ytlal Surveys (DGGSI M. f.r0upl.e Sri,. (Tele. .Ht 277-6615) ne • 'Ahrra9e. Alaska 99501 ') W A T 1 R W E L L A I t 0 A O Or1111n9 Conf�ny ks,er .r, et. -J ((.a.. r. eta bnv artgr r - Ys.Gq. Lx.l It.. t Orltilns Permit is.. ONilOie o<tiLL ►lure toe.l.t either la. Is. or It. A.D.L. M. No -5687 P. 2 STATE OF ALASKA DMATN2HT Of NATURAL BESOOIIC[S Ia. jjlueeuph % Subdirlslm Irl i P K. Let 1 RIKb // IA /Piet len I / / Sect lm M. T.un.AlP Mn9a nar 4lan It. Ol.t K* amid Olractlm tree b.d IntOrwtlOne Street Address and ACM 01 well Lmetion ���,ev Prfl,C J. OWER Of WILLI Addeesst AI1.; I.Orocll. ii6.- rl ri-%IV/ 2. WELL LOG feat D•Iw url ea A4x41 Tiros foe bttee /. WELL OEPTIt (covoletw) SWr4c• [4wtlee Oe t• al Coaylat '/} ft• J • lee S. ©GBI• lml ❑Notary 00rlwn ❑perk 0Au9.r ❑d.ttee ❑Bored ❑Otht,r .'/ .• ' erre 1/ • •/�,• / ,; ' It .e I /•!!/ / r 6. USC; VOoa.stld ❑/ubllt suPPly []Industry 01 re 11.t INN ❑ Ago, ISO ❑eomearclal Yell ❑Othari G r •: !' I/. Pry r'# + O r / 4 r 4217❑Tris ! ,! `" i ,., e'IL�,` r•%. ! ! 7. CASING: ❑Thr Wed ❑We JO d I in. to A1001. Depth A. Wal9ht J"? lbs/ft. _4. to ft. Depthti!.• w•./Ar ~.. rI I [. FINISH Of WELL: 31st/Alh flpr Laa9ta: set ba Men ft. .,A flctlnlist 9. STATIC WATER LEVEL, r•r I/ ft, ❑Amami f'e.1w 4M surfaea Type Of A ...ranentt 10. PWAPIK LIM bel. lend saffaca ft. of ler Nr, p ging D•f•0. fl. after he,. pWyln9 D•/••• 11. WELL HUD COMPLETION, In AfOpvd pit ❑rltlaee AaPt•r mochas above Ona 12. &ROUTING, Wall cm,twf, 0 V4 ❑Au At rlei: ❑Neat Caeant ❑Other, 1} I": (it available) W Lmlth of Drop Pipe ft. 9-aecity S.F. Type; clsubserslble ❑A•elfracetlnD ❑�.t ❑own 1/• REMARKS, •f:,,r ,/IA , !i IS. WATER WILL COMMUTOR•S CCRTIr ICAT10u1 This reit ws drilld „PdvP of Jurisdletim and this [@poet 4 tow w the halt of miry Mrorl0l9a a,,f bell,(, n,plfl@r@d ane la • rrl h'• •• ') •• i • •OAt poll •CNH @r Addr,sst I<•/t J.'. :ere 1 .l ..♦ •'I Stq..d: ' DJeeI '1 . Vther•aN aprb@nO bee for. 02-WUR "'• '.•••.-•••'•••• •^•�. - .•.•..era, PINK - Drillers CAAMT - Cvatoa@e MUNICIPALITY OF ANCHORAGE, DEPARTMEN, OF HEALTH AND ENVIRONMENTAL PR[. ~CTION ~) DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date / b GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or dire~tion~) (b) Applicant Name g~ ~ ~~ Telephone:~ome -~--/5~O Business (c) Applicant is (check one): Lending nstitution ~ ~builde~ Buyer ~; Other ~ (explain); (d) Lending Institution' Address Telephone (e) Real Estate Company and Agent Address -. ';i.?~'elephone (f) Mail.t,h,e HAA to.the following a.,dd~ress:, .3. TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well,'[~. Community Fl Public [] . - .. "'- Note: If community well system, must have written confirmation from the State Department of Environmental Conservation aL~esung" "- to the, __,:,_,e~,~¥ and status. .. ·.. 4. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State De partment of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDINg, ,,4SPECTIONS, 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 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 Frm Address Date 4 Engineer's Seal Terms of Conditional Approval The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations g~ven in paragraph $ 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 n 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 omissio.n.s.._.in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA, HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONIviENTAL PROTECTION 1987 w,,, ~^~^ RECEIVED CHECKLIST - FEBRUARY 1984 264-4720 £i~ ~ ~r~,~ Legal Desc[iptio, n: Well Classification Well Log Present (Y/N) Total Depth / ~ Static Water Level / Casing Height Above Ground ~ ~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) '~ Depression Around Wellhead (Y/N) Separation Distances from Well: - k L t / TO Septic/Holding ~an on o To Nearest Edge of Absorption Fie~t ~(~)~ On Adjoining Lots To Nearest Public Sewer Line . ~/ ~ To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by J" Water Sample T~t Results Comments ~ SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on Holding Tank High-Water Alarm (Y/N) . . Separation Distances from Septic/Holdin~Ta~t~k~ To Water-Supply Well ) t~("') To Property Line TO Water Main/Service Line - Course W e .~.~--~ Comments ¢/~.,_/~ "~ 5. / ~B ~ ~"alNo. of Compartments F°undati°n Cle~7 ~Y/ Date Last Pumped · for ,, Temporary Holding Tank Permit (Y/N) /~//~ To Building Foundation To Disposal Field !'~ To Stream Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / '~ ~///-~'~4 Date Installed /,, ~;)// /~,/ t~ Width of Field ~ '/',~' ~ -~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Type of System Design Length of Field ' ~ ? / Depth of Field ~ ~ Separation Distance from Absorption Field~) TO Water-Supply Well t O~') ! ['~_) TO Property Line To Building Foundation ~ _,~ I (~ Lot ~/~O~'~ To Water Main/Service Line ~ ~ To Stream/Pond/Lake/or Major Drainage Gourse To Driveway~arking Area, or Vehicle Stor ge Area '1 To Existin,,~,,,or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION Date Installed _ __ Size in Gallons .__ ~ole/Acc~ss (Y/N) "Pump On" Level a~.,,,,.~ / "Pump Off" Level at High Water Alarm Level a~P---.--..--~ Vent (Y/N) Tested for / -~-~~!ng Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have cheGke~, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~7~~.. Date / ~,~ ~-~' :i ,~ '~ //I -- u~",;,/' "' ~'_/zl~.$~. -' / -- Company,J~'~. ~,.~ ,~.,~,2e/,~, I~ ~'~',~ No. Date of Payment ~"~'-'~ Amount: $ ? (~)/'") , C)C_._~ MUNICIPALITY OF ENVIRON .tV~,~ ~Y,~C~ Page 2 of 2 72-026 (11/84) 2 RECE IYE, NORTHERN TESTING LABORATORIES, INC. 600 UNIVERSITY PLAZA WEST, SUITE A 2505 FAIRBANKS STREET FAIRBANKS, ALASKA 99709 ANCHORAGE, ALASKA 99503 907-479-3115 907-277-8378 James Sizemore 6410 Switzerland Drive Anchorage, Alaska 99516 Source: L16, B4, Bruin Sample ID#: A081787-6 Date Arrived: 8/17/87 Time Arrived: 1615 Date Sampled: 8/17/87 Time Sampled: - Date Completed: 8/20/87 Parameter Unit Result ADEC MCC$ Nitrate-N mg/L <0.10 10 Reported Carol J. Oarri~Sn, Vice-President Date: 8/20/87 $ MCC = Maximum Contaminant Concentration - ' ' DA3~ RECEIVED ',:'~; " INSPECTION APPOINTMENTS /t ~,/ TIME TIME DATE ~L~~ DATE DATE \'~'/ f MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 825 L Street - Anchora~, Alaska 99501 ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION SEP A 981 Telephone 264-4720 DIRECTIONS,. Complete all parts on page 1. Incomplete reques~ will not be proceed. Please allow ten (10) days for processing. I~pPERTY OWNER__ , r -- ' ~ ..I,.~o~E .... MAI~iNG ADD~ ~S& ~ ~ 2. BUYER ~ PHONE MAI LING ADDRESS I PHONE 42 REALTOR/AGENT MAILING ADDRESS ' ~ 5. LEGAL DESCRIPTION I 6. TYPE OF RESIDENCE [~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY 8, SEWAGE 'DISPOSAL SYSTEM 1~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF~BEDROOMS [] One [] Four [] Two [] Five ~' Three [] Six [] Other ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS ' · [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I NDIVI DUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: PERMIT NUMBER DATE INSTALLED NSTALLER SOl LS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank [Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS E~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE 72-010 (Rev. 6/79) '~,'2. 5 "1 ." '- /!., IXl (] H (~) t~/",, (~i i~, ALASKA (~:t0'/) '26,'l 4i 1 I (if ()1:1(~1 M. ',JUl I. IVAN, M A Y () i !)I:F'AIi]'[,/IFI'Xl i ()t': ttt /\l I t ,i'~i i r' ',.'ii~t 'Jtvll tJ IAI September 30, 1981 Daniel R. Morgan Star Route A Box 1797-M Anchorage, Alaska 99507 Subject: Lot 16 Block 4 Bruin Park Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The sewer system has not been approved by this department. Before approval may be granted, the system will need to be approved by either this department or a private engineer. If there are any further quest,ions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: First National Bank of Anchorage Post Office Box 3128 99501