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HomeMy WebLinkAboutSUNSET HILLS BLK B LT 24Lo 'F (i/ ~,,I,~ iI,,,~,~ )~ '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 "['PHONE []NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION t NO. OF BEDRooMs, ~ ~ Manufacturer Material No. of compartments ~ ~ U~q. capacity in gallons IF HOMEMADE; Inside length Width ' Liquid depth 9~ I, DISTANCE TO: Well Dwelling ,ERMITNO. O ~ Manufacturer ~- -- Material Liquid capacity in gallons Foundation Nearest lot line ' PERMIT NO, OTHER -- PIPE MATERIALS SOIL TEST RATING INSTALt_ER R EMAR KS /'/~ ' L¢ ¢· 72-013 (Rev. 3/78) A ' cherage POIJ(,~t6 650 ANCI IOttAGE, ALASKA 99502 0650 (907) 264 4111 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRO'rECTION Permit It:840487 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 24 Block B Sunset Ilills Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Mnnicipal 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 and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, SupeYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 PERMIT NO: 84048? RPF'L I CANT: ADDRESS: Ct]NTRC:T PHONE: DRVE KIESTER P 0 BOX ANCHORAGE., RK -~45-0457 LEGRL DESCRIP: LOT ._ I-."E: LOT LOC:RTION: · MFt~-~. BEDRuuM:=,: SUBDIVISION: SUNSET HILLS LOT: 24 SECTION: J. 900L~ (S6t FT. OR ACRES) SUNVIEW DRIVE BLOC:K: B LI=,TE[ E, EL[ ~1 ARE ]'HE OPTIONS AVAILABLE TO '¢BLI IN DESIGN'ING ~r'OLIR SE'PTI]: _,T.::,TEH. L. HOC=,E THE I]PTION THRT BE_,T FITS *¢OI.IR SITE. 4.0 0.5 4.5 :/.6.0 ~:2. 0 '18. 9 250. 0 DEPTH TO PIPE DOTTOM (FT.) 4. 0 ~.o GRAVEL. DEPTH (FT.) 6. 0 ¢-¢ TCITRL DEPTH (FT..'.. i,0. 0 /o.0 GRRVEL HIDTW (F'"T.) 2. ti ,~..~ GRAVEL LENGTH (ET. ::, 43. 0 ,~ GRAVEL VOLUME (CU. ~r'DS. ) 25. 8 TFINK SIZE (GALS) ~., 250. 0 SOIL. RATING (S6). FT. ,.."BR) t28 TANK MUST HAVE RT LEAST TWB C. uMFHRFMENF_ I CERTIFV THRT: ±. I RM' FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BV ]'HE MLINICIPRLITY'OF ANCHORAGE (MOA) AND THE STATE OF RLFISKR. 2. I WILL INSTALL THE S~'STEM IN RCCORDRNCE HITH ALL MOB CODES AND REGUI_RTION~., AND IN COHPLIRNCE WITH THE. [:,ES~GN cRITERIA OF THIS F'ERMIT. 3. I WILL ADHERE TO RLL MOA AND STRTE OF RLRSKR REQUIREMENTS FOR THE SET BACK DIB'TRNCE~ FROM RNV EXISTING WELL, WRSTEI4RTER DISPOSAL SYSTEM OR PUBLIC SEWERAGE Sk'STEM ON THIS OR RNV ADJACENT OR NEARBY' LOT. 4. I UNDERSTAND TFIRT THIS PERHIT IS VALID FOR R MRXIHUM OF 4 BEDROOMS RND RNb' ENLARGEMENT HILL REQUIRE RN ADDITIONAL. PERHIT. IF R LIFT ,~TRTION' IS INSTF _LED IW RN RRER COVERE[:, B'¢ MOA E:UILDIN~ CODES., THEN <l) R~LEC:TRICRL PER'lIT RND I~SF'EC:TION MUST BE OBTRINE[:u ,::~) RS-Bt.lILTS WILL NOT B~ R~ROVED WITHOJT RN ELEL. TRICRL IN~F'EC:TION REpORT.~ FIND (~) THE LEC:TRICFdL~NORK%MLIST BE ,I)O'~E E:~' ~ICENSE[:, ELEC:TRIC:IRM. . ............. ......... ........... .... RPPLICRNT I =,=,IJE[ ~o ~ [)RTE: PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTR AND ENVIRONMENTAL PROTECTION BBB L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST / SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS LoT ISLOPE 15o ~ ILL& SITE PLAN WAS GROUND WATER ENCOUNTERED? N O [~ O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Droo PERCOLATION RATE ~/~ ( ~/~/~.)/'~ TEST RUN BETWEEN FT AND FT PERFORMED BY: ~-~ 72-008 {6/79) P~rmit APplicant: Location: MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmental -otection 825 Street, Anchorage, AK. _30]. 264~4720 * * * HANDWRITTEN PERMIT * * * ~©7~ 7 WELL AND/.~eJ~--ON-SITE SEWER PERMIT ~/a~ Z,BcO ~ro~ k Phone Number: ~-J~/~ Legal Description: 8o~ T~pe of Soil Absorption System I~: Trench: Drainfield: ~/ Seepage Bed: Maximum Number of Bedrooms: Lot Size: ; l?BO;t Holding Tank: Soil Rating(sq.ft/br) ~ The Required Size of the Soil Absorption System Is: ' DEPTH LENGTH <--5/ ~ GRAVEL DEPTH /~ WIDTH 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 = /~,%-O GALLONS * * Rermit 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. are Other requirements may apply. Specifications and construction diagrams available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 $ 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) S&gna~: SWP/024 (1/81) and wells as I understand that the residence is remodeled Applicant , the on-site sewer system may require enlargement if to include more that 3 bedrooms. Issued by: Date: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATIOhl TEST SLOPE 5- 6 7 8 9 10 11 12 13 14 15 16 17 18 19.- 20.- 5-E IE ZS~ ~97~ COMME-NTS ~, V.r.T~'/A SITE PLAN % \ WAS GROUND WATER ENCOUNTERED? ~ O t~ O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~./-~ .... ~ %- PERCOLATION RATE (mLnutes/inchl DATE: 72-008 (6/79) JOHN H (JACK] KIMBALL OWNER ~,, ~N. COHTRACTOliS q~ MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECi'IOIq LO'T ¸,% MUNICIPALITY OF A/~CHORAGE DIVISION 0F ENVIRONMENTAL REALTH DEPARTMENT OF I~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date. (a) Legal Description .(~.include lot, block, subdivision, sec,tion, township, range) _Lm~~ ~.q j~Jf~_3%___~,~)~!~mT ~41_t.t.__J~ '~[~.C.. Location (address or directions) (b) Applicants Name ]'~]L ' ~'~ ~'~ ~/I ~, ~;~.e~one - Home Business (d) Applicants Address Applicant is (cheek one) Lending Insti~ution Buyer ~I; Other [-~_~ (~xplain); Lending Institution Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2o Ty_zRe of Residence Single-Family~ Number of Bedrooms 3~ Water ~u~l~ Individual Well~'~ Other (dsscribe) Community ~ Public Note: If community well system, must have ~r£itten confi[~ation from the State Department of Enviror~nental Conservation attesting to the legality and status. ~.Vis o~.! Onsite ~ Public ~1 Commun:Lty ~ Holding Tank ~ Note: If community well system, must have ~itten co~irmation from the State Department of Environmental Conse~ation attesting to the legaiity and status. [Page ], of 2] Engineerin_g Firm Providin,? I~_~nsp_~ctio,n_~.~ Tests~ File Search~D__ata and Info__~__at_~io~n As certified by my seal affixed hereto and as of the validation date sho~ below, 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 info.etlon obtained from th~ ~nicipality of Anchorage files and from my investigation and inspection, the on-site ~tar supply and/or wastewater disposal system is in compliance ~th all Municipal and State codes, ordinances, and regula~ tions in effect on the date of this inspection. Name of Fir~~f~,Cj~ Address (ENGINEER SEAL) Approved for~/~ bedrooms By Approved ~______ Disapproved Terms of Conditional Approval .~nditional _~__ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DttEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOI~ BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ~ASKA. THE ~tEF DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERBL 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 ~ PROFESSIONAL ENGINEER'S WORK. (DHEP SFa%L ) RR4/ej/D18 [Page 2 of 2] 7-19-84 HEMICAL & GEOLOGIC~4L L.4BOR~4TORIES OF .4LASK/I, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER ' 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATFR SUPPLIER WATER SYSTFM: I.D. NO. Water System Nl~me Phone No. '. Mailing ~dre~ (*) See h on back I-4 ~ L~£ Cit~ State MO. Day Year Zip Code SAMPLE TYPE: ~-. Routine [] Check Sample (for routine sample with lab ref. no. E} Special Purpose ,~Treated Water Untreated Water SAMPLE NO, , I LOCATION Time Collected Collected B~' TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: /~ Satisfactory ,'L [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail, Date Received ~ Time Received Analytical Method: [] Fermentation Tube ~ Membrane Filter Lab Ref. No. Result* L j L J AD~alyat BACTERIOI. OGICAL WATER ANALYSIS RECORD READ iNSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Flitch Direct Count Verification: LTB Final Membrane Filter Reel)lis ("~ Reported By ½~ BGB Date Tlmo: 'rNTC: Too Numerous To Count CoilformllOOml Collformll00rnl ._,r - ~ ae WELL DATA Well Classification __ R ~---~ , Well Log P~esent (Y/N) Total Depth ~'] Cased to Static Water Level ~ % Pump Set At 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 . C leanout/Manhole 'Water Sample Collected By Water Sample Test l~sults Co~nts MUNICIPALITY O~ ANCHORAG['~ p£P1. OF HEALIH & ENVI~©NM~NTAL PROT[C'FION MUNICIP~I~ OF ~C~GE (MOA) NN~ AU~O~ ~OV~ ([~) CHECKLI~-FEBRU~Y 1984 ~C[l~[~ Legal Description: ~L~gr ~,~F~ Da~e Co~e~e~ O~T I~ ~e~ IO~~ ~pth of G~outing ~ O ~ ~ Sanit~y ~al on Casing (Y~) ~ ~pression ~ound ~llhead (Y~) ~ ; On Adjoining Lots I~ ; On Adjoining Lots _ To Nearest Public Sewer To Nearest Sewe'r Service Line on Lot vl ..i Be Date Installed ~ D/~ $/~ ~ _ Standpipes (Y/N) ~f Depression over Tank (Y/N) size IR~O No. of Comp. arC,nfs Air-tight Caps (y/N)_~___ Foundation Cleanout (Y/N) N [)ate Last Pumped ~, Pumping/Maintenance Contract on File (Y/N) ~/~ ; for __ Holding Tapk High-Water Alarm (Y/N) h//~ %%mporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Building Foundation ~ 7 To Disposal Field IO To Stz, eam, Pond, L~ke, or Major D~ainage To Water-Supply W~ll To Property Line To Water Main/Service coup. se __ Com.snts Receipt ~ Date Paid: fUao u n t: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~)d.~- /~/ Width of Field 30 '~ Square Feet of Absorption A~ea Depression OVer Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~ ~ Depth of Field // ' Gravel Bed Thickness ~ / Standpipes P~esent (Y/N) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Io~ TO P~operty Line ~ ~D To Building Foundation ~ To Existing or Abandoned System on Lot NO~ ; On Adjoining Lots ~) To Water Main/Service Line ~0~1~ To Cutbank(if present) To Stream/Pond/Lake/c~ Major Drainage Cout~se ~O~ To D~iveway, Pa~king A~ea, o~ Vehicle Storage A~ea ~O Corm~nts D. LIFT STATZON NoN Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dir~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Cor~nts ** Check Permitted Bedrcom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~~ Company KB1/dL/s Date MOA No. [Page 2 of 2] 2-15-84