HomeMy WebLinkAboutSUNNY VALLEY LT 15 REMLo'F
15"
MUNICIPALITY OF ANCHORAGE ~, ~/
~J i,~ 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
.~"/ [] UPGRADE
MAI LII~G/~DR~ ESS ~ /' C _~' ~
O~Cq~PT~ON .~ ~" / ~ '' ~ ~ ~
LOCATIO~ / / . [ /~ J NC. OF ~E ROOMS
J Well .~- / ~ Absorption area Dwelling ~ ~ PERMIT
Materia ~6 No. of coT~ments
Liq. cap~,~i in OhS IF HOMEMADE: Inside length Width Liquid depth
DISTANCE TO: Well Dwelling PERMIT NO.
Manufacturer Material Liquid capacity in gallons
DISTANCE TO:
Total lengt~of ~ Trench wi~ Distance between lines ·
Top of tile t~inish grade Material beneath tile ~ r
. i Total effec~soEption area ,.~
Length Width Depth PERMIT NO. '-
Type of ~rib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO; Building foundation Sewer line Septic tank Absorption area(s)
OTHER I
72-013 (Rev. 3/78)
PERMIT NO.
8PPLICBNT
~ )CRTION
ZGRL
( 8±038~ )
DEPBRTMENT ~HERLTH RND ENVIRONMENTRL ~.,~TECTION
825 ~L~ STREET¢ RNCHORRGE, BK. 9950'±
264-4?20
HRMRNN CONST,
LOT ~. SUNNY MRLLE"/ SUE:
PO BOX 617 ERGLE RIMER
LOT SIZE
~WPE OE SOIL RBSORP'f'ION SYSTEM IS: TRENCH
~IAXIMUM NUMBER OF BEDROOMS
SOIL RBTING (SQ FT?BR)= 140
FHE REQUIRED SIZE OF' THE SOIL BBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF ]'HE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCRMATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRMEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVRTION (IN FEET).
PERMIT RPPLICANT HAS THE RESPONSIBILIT'¢ TO INFORM THIS DEPARTMENT DURING THE
INSTFILLRTION INSPECTIONS OF ANY WELLS ADJRCEN'f' TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES TFIRT THE WELL WILL SERVE.
'r~..4Cl ,:: 2 ::, Z P-,~ ~;,F"E r':-f' I CJli"-,~$ RRE F-."E~] U I F-:E[:.
BACKFILLING OF ANY S'¢STEM WITHOUT FINRL INSPECTION BND APPROMRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL AND RNY ON-SITE SEHRGE DISPOSAL. SMSTEM IS
100 FEET FOR A PRIMRTE WELL OR t50 TO 200 FEET FRO~I R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL. _
MINIMUM DISTRNCE FROM R PRIMATE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY APPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRAMS ARE
AVRILRBLE TO INSURE PROPER INSTRLLBTION.
F"E~'~:~--1 ~; T EXP :E I.-t'. E:~; [)ECEI"IBEF--~ 2-:1.. 1L--]JE:!
I CERTIF"r' THAT
1: IRM FAMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIF'FILIT'¢ OF ANCHORRGE.
2: I WILL INSTRLL. THE S'¢STEM IN RCCORDRNCE WITH THE CODES.
]:: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE I~ REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
PERFORMED FOR:
LEGAL DESCRIPTION:
1-
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
~j ,~.~/, [] SOILS LOG
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L. Street· Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SLOPE / SITE PLAN
//-/:0
WAS GROUND WATER y,,~.~ SE
ENCOUNTERED?
,,r ~o
IFYES, ATWHAT ~//~! E
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
minutes/inch
FT
PERFORMED BY:
72-008 (6/79)
PERMIT NO.
~'.IL~.-.N ..~ ,]: ][ ¢ ':'~[_ T T'.'r' ,],F I-3NE:H
DEPRRTMENT ~t-/HERLTH 8ND ENV IRONMENTRL ?-~OTECTI ON
825 "L" STREET.. 8NCHORRGE, RK. 9950~
264-4720
,:] 8~0202 )
RPPLICRNT
LOCRTION
LEGRL
DRVID RIC:HRRD
NESTLRKE DR.
LOT 1.5 SUNNY VRLLEY SUB
?05 MLILDOON RORD
LO]' SIZE
~8-2082
4~560 SQt. IRRE FEET
MINIMUM DISTRNCE BETWEEN R NELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
100 FEET FOR R PRIVRTE NELL OR :t50 TO 200 FEET FROM FI PUBLIC NELL DEPENDING
UPON THE TYPE OF' PUBLIC WELL.
MINIMUM DISTRNCE FROM FI PRIVRTE WELL TO Ft PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY '.5ENER LINE IS 75 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN --,':0 DRYS
OF THE NELL COMPLETION,
OTHER REQUIREMENTS MR¥ RPF'LY. SPECIFICRTIONS RND CONSTRUCTION DiRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
F"EF-:~'"I Z T E::-::F' ][ F.:ES [)EC:EME:EF:: '-:~: :..1_ ..
I CERTIFY THRT
i: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I NIL[_ INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
SIGNED: ..............................................
CFi~ I~8~T [:,R','ID RICHRR[:,
V4. 0
94. t~:::¢
by T. OF HEALTH &
ENVIRONMENTAL PROTECT ON
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE- Started ~/?') ~/~'~ Ended
PE~IT NUMBER
DEPTH OF WELL / C r~
STATIC LEVEL OF WATER FT
APR 2 8 1981
RECEIVED
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From c~ Ft. to ~
From ~ Ft. to / 3~'
From Ft. to
From I .)" Ft. to ~?~\
From__Ft. to
From /~':,),-, Ft. to ~
From Ft. to Ft.
From ~'(' Ft. to ! 6 t Ft.
From /6 / Ft. to ! ~(o Ft.
From Ft. to. Ft.
From I :~ ,~ Ft. to /c~ ~F~' 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.
Ft,
From
/¢~rom
From
From
From
From
From
Ft. to Ft
__.Ft. to Ft
Ft. to Ft,
Ft. to__Ft.
Ft. to Ft
__.Ft. to Ft.
Ft. to. Ft.
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:
DRILLER'S NAME "
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DtVISlON OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTFIORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date 7/'~ /~''~
(b)
(c)
(d)
(e)
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section., township, range)
Location~l(address or directions)
2
Applicant Nam ~. ~ ~Z Telephone: Home
Applicant Address ~ ~_
Appli~nt is (ch~ck one): Lending Institution ~; Owner/builder D; Buyer ~; Other~ (explain);
Lending Institution~
Address
Real Estate Company and Agent
Address
Telephone
Business
TelcDhone
(f) ~ the HAA to the following address:
TYPE OF RESIDEHCE
Single-Family~ Multi-Family FI
Number of Bedrooms ~
Other
,/
/11t I1'\ '
3. WATER SUPPLY
Individual Well~- Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
: onsite)~J~ Public [] Community [] Holding Tanl~ J~
Note: If community well system, must dave written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE 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 regulations in effect on
the date of this inspection.
Name
of
Firm
Address '~t
Date
Telephone
DHEP APPROVAL ,'" '
Approved for Bedrooms by
Approved .~ '" Disapproved
' Terms of Conditiona! Approval
,/~:l\~\''~'
Conditional
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representation9 given in paragraph 5 above by an independent pi'ofessional
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 eng'neer s work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCH~E
DEPT. OF HEAL~J-I & MUNICIPALITY OF ANCHORAGE (MOA)
ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984
RE(::EIVED Legal Description:
Well Classification -~ · ~'~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present ~]'~) · Date Completed ~-T'?.~- ~,1 Yield
Total Depth _ [ L~ ~Cased to Z5¢C:) ~.-'~ "~ Depth of Grouting
Static Water Level ~ ~/,r Pump Set At ~.). ~-
Casing Height Above Ground t ~ '*
Sanitary Seal on Casing(~)'N)
Electrical Wiring n Conduit4~JJ~) Depression Around Wellhead
Separation Distances from Well:
To Septic/Hold;,,~ Tank on Lot . ~ ¢() I~'L ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~ z.~L-~.~ ~ ; On Adjoining Lots
To Nearest Public Sewer Line ¢/A To Nearest Public Sewer
r~ /.~ To Nearest Sewer Service Line on
Cleanout/Manhole
Water Sample Test Results
SEPTIC,~iCL~ TANK DATA
Datelnstalled '~-').~¢t~~, Size \"7~'~ , Nc. of Compartments
Standpipes~'/N) Air-tight Capsd~) Foundation Cleanout ¢~'N)
Depression ove~ Tank (Y/~i~) '" Date Last Pumped ~ ~ '~':~ - ~'
Pumping/Maintenance Contract on File (Y/N) ~ J/~. ; for ~
Holding Tank High-Water Alarm (Y~N) ~'J/.4 Temporary Holding Tank Permit (Y/N)
Separation D~stances from Sept'c,'~;o',dh~§ Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depressiort over Field (Y~P .4
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I /"'~°~
To Building Foundation ~' ~"~
Lot ¢'J/~
Type of System Design
Length of Field
Depth of Field ~ f "'~
Gravel Bed Thickness
-~ ~'~ '1~' Standpipes Presentd~N)
Date of Last Adequacy Test
To Property Line
; On Adjoining Lots
(
To Water Main/Service Line t ~, -b
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Existing or Abandoned System on
!
To Cutbank (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** 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.
MOA NO, ¢~I"~'~'0 0 ~
Signed
, ~ 8RB 196~
Receipt No. ~(~C~5 Lo ~)
Date of Payment ~'"7~ '(~t5
Amount: $ ~¢D ~
Page 2 of 2
72-026(~1/84)
Address H
Type of Resi~nce
Water Supply
~ Individual. A~AOH WELL LOG. A w~l Icg is required for all wells drilled since June 1975.
~ Community ~or walls drised prior to lhal dale, give well depth (attach Icg if available).
~ Public Utility When Connected to Public U
~ 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:
/./~
(L~) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) C(~'~IIT[ONAL APPROVAL'
DATE '
Soils Rating Date Sewer Installed Well To Absorption Area /~ Well Log Received ~,~
INSPECTION APPOINTMEN
.=DIME ,;. TiME
,NS.EDTO. .NsP OR. .NsPECTO.
MUNICIPALITY
) ~EPARTMENT OF HEALTH ~ E~VIrO~ME~TAL
ENVIRONMENTAL sANITATION DIVISION
Telephone 264-4720 R E C E I V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
5. LEGAL DESCRIPTION
STREET LOCATION ~ , ~
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One ~ Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY . [] Three [] Six
[] Other
7. WATER SUPPLY
~[~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[~ PUBLIC UTI LITY depth (attach log if available.)
E. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** /~-¢/" .YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
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