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Home My WebLink AboutT15N R1W SEC 8 LT 49Ltq (~ ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] NEW LEGAL D~CRIPTION ~ / DISTANCE TO: IWell // ¢ , Absorptio~ea%~ , Dwellin:r PERMIT NO. ~¢ Inside length Width Liquid depth % Manufacturer Material Liquid capacity in gallons ~ . DISTANCE TO: 7 ' 2(3 ~i~;I No. of lines/ Le.gth Ce:~ine I.~?¢ lines ____Trench wiTtho inches Dist;nce b ,~y] n~ ~~'~ I Top of tile to finish g~.~ / ~ Material beneath tile /~ i:inches Total ef f~tive ~ ~I% ~ab~ti°n'~area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter J epth Total effective absorption area m DISTANCE ~O: Well Building foundation Nearest lot line ~u/-~J//Z~ Depth Driller Distance tolotline PERMIT NO, ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank AbsorpBon area(si TEST RATING~ ~ SOIL G, Rev. 3/78) DIEF:'ARTMEI',rl" OF' HIEALTIq AND ENV I RL')L',IMI~I',FF(41.., I:'l,,O:" "I'E.L: '" ..... ] IGIl~ G25 L ~'I]REET, AIxICHGRAGE~ Al-::: 9950:L .?.6 4- 4'7,~ () PERMIT NO~ DATE I GGLIED ~ APPL I CANT ~DDREGG LEGAL l'l~ X C) fl'",4 '--" S:"~ '.E '"ii" E:: ~,::.:~ IE I~,.~Jl lEE: F~',: F>' EE:'F~: ~"*'11% 'T ISAGI..,EE RIVER,, AK 99577 /¢~ ~ '~ '.~;~f~- ' GUB[) I V ]: G ]: ON ~' WA L,OT: 49 BI.:OCK ~ SE:CT I GN: D I"GWI~GHI F:': :LSN .RANGIE~ 1W 2,, 5A (liD,, FI". GR ~CREG) Lis'Led I:)e],Dw are the op-I:.:i, clrp,:~ available '1:.o you in dE~s~ign:i, ng youl~ sep'L:i.c sys't..em. Cl"~oose 'Lhe op'~.ion that best fits your' s:i.'Le,, ):)EF'"rl.4. TO F' :l:l:::'lE BOTTOM (I:'T.) 4.0 Zl.,, 0 E}RAVE:L DE:F:'TH (F"'I".) 0,, 5 :L ,, 0 I'OTAL DEF:'TH (FT.) 4.5 5.0 GRAVEL W]:DTH (F'T.) :1.4-. c) 5,, 0 BRAVEL. LEI'4GTI-I (F"r ,, ) ,S?G. 0 45,, 0 GRAVEL VOLLIMIE (CU. YI)G. ) 14., 6 :L2,, 5 TAIqI< G I ZE (GALG) 1., ()00,, 0 .~-.~. 1,0()(),, 0 .~i..~. SG]:L.. RATING (Sill. FT. /BR) I]5 I]5 '~'-]~ 'T'ANK MLIGT HAVE A'T' - t~-- LEA¢ J TW[] C[][¥JP(~RTJvJENTG I c(~r"L.i,f¥ that: 1. I am fami].iat- forth by the Idun:Lcipali'Ly of Andqora(Te (MOA) and the ~ta'lie of Alaska. 2. :[ Nil]. J. ns'La:l. 1 'Lhe system J. rJ alCCOl"darlc:6~ W:i.t.I'I ail ["IGA codes arid ' and ir: compliance ~i'Ll'J the design cr'Jt.r~r:La o¢ this per, mit,, :5,, Z will adher'c.>'to all VI[I~ ancl StaLe of Alaska r'<:~qui~-6~menks for' the sot back dist. d, nc:es from any existing well:, wastewa'f, er' disposal syst, bm of public sew~::¢r.,',lge system on th:Ls or any adjac:e~rrE or near, by lot. I Lirid~)l,S'k,:~l]d t. ll&v~. 'kl'lJ,~ permit is va].~d for a fna;~:i, mLim c:)¢ ::~; bedr'ooms and any E)rl].af'(;j(efJl(:)rit will r'(:~quir'6~ an additJ, or'ial perm:i,t, ]:F:' A I_]:F:'T .:::~IA1 ,[GN I,~ INGI"AI,-I...ED IN AN AREA COVIERED I3Y MOA BU:I:L.D,I:NG LODL,.I!, THEN (1) AN I:LEL,]I',.[L, AL I LI',MIT AND ],N,..fl: ECl IUN MUGT BI::: £:L. I A.[IIE..I.), (?.) AS'-BLJ:I:LTG . W.(LL. NOT ;BE AFI::'r~')WITIIOtJT AFl EI...ECTI"I:[CAL IN,'3i::EC'T'IGN fU:}::F'OIUr',~ AND (..3) THE E:I_.IECTRICAL. W£]~: I"[L~?~,~*/Y~:.':/r~qE ¢T~Y A L. ICENGI:-~D ELECI'F;:]:CIAN,, ' """:"' .............. : ................................................. ......... AF>PL. I DANT~~ F::IqG 'G DAL,E I¥1U[~EF~ -- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIFIONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TFST ~ SOILS LOC [] PERCOLATION TEST PERFORMED FOR: · EGA' DESC.,P',',ON 1 2 3 4 5 6 7 8 9 10 '11 12 13 14 15 16 17 18 19 20 SLOPE DATE PERFORMED: / SJ'FE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ {minutes/inch) COMMENTS PERFORMED BY: 72-008 (6/79) TEST RUN BETWEEN FT AND ---~ FT // / CAIIAI~Y ? Custolt)or MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl. TH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAl.. OF ON-SITE SEWER AND'WATER FACILITY 264-4744 Application Date July 25, 1988 GENERAL INFOFIMAI'ION (MUST BE COMPLEI'ED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 49; Section 8; T15N; R1W Location (address or directions) Corner of Birch and North B:Lrchwoo8 Loop (b) Propehy Owner Lehrf~uhl¢ /'~?~ Lc_ Telephone: (c) Lending institution Mailing Address Home 688-3898 _ Telephone (d) ' Real Estate C0mpaHy a~d Agent RED CARPET/GREATLA~D - Lola Pederson 'Address P.O. Box 633, EaSe River, Alaska 99577 lepl Ob ...... 694-9125 Te ] e "' Business (e) Mail the H,~A to the followina address: or: Check here [~, if hold for pick up. List contact person and day phone number below. ,g &._S EN~Tf~'.R~Tf',lG~g4-297q ordered by Lola Pederson TYPE OF RESIDENCl-' Single-Family ~ Number of Bedrooms" 3 WATER SUPPLY Individual Well L~ Community [] Public [] Note: If community well system must have written confirmation from the State Department,of Environmental Conservation attesting to the legality and status. ~ ~ SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of E:nvironmental Conservation attesting to the legality and status, Page 1 of 2 72-025 fRev 8/861 Fronl 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 Date Eagle River, Ajax,-- DHHS APPROVAL Approved for ,/~,,~.x'~ ~.,~ bedrooms by Approved .. ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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 72-025 fRev 8/86) Back _?./~GMUNIOIPALITY OF ANCHORAGE (MOA) ~ ~,~C~ \~I~L'rH AIJTHORITY APPROVAL (HAA) ~u ~t~ ~ 264-4744 Well Classification ~ f--~l~\ ~O/"~q ~ __ Legal Description: ~L.~:,~ ~ , ~-~' ~:~' / If A, B, C, D.E.C. Approved (Y/N) Well Log Present~¢~'4) I '"// Date Completed/ "~ -'~-~-\ - ~ Yield Total Depth \ ~ Cased to ~ ~ ~ Depth of Grouting Static Water Level (~ Pump Set At Casing Height Above Ground ~ [~ ~ Sanitary Seal on Casin~) Electrical Wiring in Conduit ~N) ~/ Depression Around Wellhead (Y~ Separation Distances from Well: To Septic/Holding Tank on Lot ~ ~ ; On Adjoining Lots To Nearest Edge ol Absorption Field oq Lot ~ ~ ~ ~; On Adjoining Lots To Nearest Public Sewer Line _ ~ To Nearest Public Sewer Cleanout/Manhole. ~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~G [~~' ; Date Water Sample Test Results ~[~¢¢~ ~¢~% B. SEP'rlC/~i'OL-B, II~L~TANK DATA Size ._~ Date Installed Standpipes ~'.'~) __*'~- -- Air-tight Caps~N) Depression over Tank (Y4~;) _ , Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) -- Seperatioe Distances from Septic/~ Tank: -:TO Water-Supply Well __ ~ \ z~ I To Property Line \ ~-~ t + To Water Main/Service Line Course 1 ~¢--~ ( 4- Comments ~'~'-FG ~-'~'~¢"'¢~ NO. of Compartments -- U),~',_ "/ _ Foundation Cleanout (Y~'-~ ~ Date Last Pumped _ ? ~'~"¢~" ,,-.I/.~. ; for Temporary Holding 'Tank Permit (Y/N) ' TO Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 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 / ~ "7 To Building Foundation Lot /0 To Water Main/Service Line /o /.+- Type of System Design Length of Field Depth of Field ~ Gravel Bed Thickness Standpipes Present(~N) Date of Last Adequacy Test I To Property Line [ ~ Jr- ; On Adjoining Lots To Existing or Abandoned System on To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) Dat~ Dimensions Size in Gallons % Manhole/Access (Y/N) "Pump On" Level at ~ ' Pump Off" Lever at High Water Alarm Level at ~ Vent (Y/N) . Tested for __ ~i~ during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Signedl certify that~__l have checked, verified, or conformedDate iit:~'O'Ay Y/(:~a'~' HAA0[:/ g uideli nes S & S ENGINEERING ~,.;_/ .... Ea~le River, Alaska ~95:, :, Receipt NO'. Date of Payment _ Amount: $ //,~ 0 .¢...~d Page 2 of 2 72 026 fRev 8/861 Back in effect on the date of this inspection. NUNICIPAhlTY OF ~CHORAGE DIVISION OF ENVIRONMENTAI, HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR UEALTH AUTHORITY APPROVAL CERTIFICATE Application Date (a) Legal Description (include lot, block, subdlvisi~n, section{ township, range) Location (address or directions) (b) Applicants Xame/jy/~2~?~/~ Z~ l~~=~___~zU ~ZTelephone ..... - Home Business (d) Lending Institution Telephone Address .......................................................................... (e) Real Estate Co. & Agent .............................................................. Address Telephone (f) Mail the HAA to the following address: . .T_~.[)e og Residence ~, ~" Single'"t amily.[~I- Multi-Family ~---[ Number of Bedrooms ...... Individual Community 4 o 0 t: he r (_~2xsc__?(?_e2 Public Note: If community welI system, must have ~'itten csnfirmation from the State Department of Enviroumental Conserwation attesting to the legality and status. Onsite .~i~ Pub:Lie [Page 1 of 2] Commnnity ~.-.i Ho.lding Tank Note: If community well system, must have written c)nfir~ ation from the State Department of Environmental Conse£vation attesting to the legality and status. 5. Engineering Firm Providin~L_~nspections, 'rests, File Searchz Data and Infor~a~'ion 3 ' 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 suppiy 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 Address__~_~[~L:',; :'/, (ENGINEER SEAL) , ] , fe_ephon¢. DttEP ~Aj21~_3 o v a 1 .Approved for ,'~-- bedrooms Approved _~>~_ Disapproved Terms of Conditional Approval B Condit:[onal CAUTION Till.'] MUNICIPALITY OF ANCHORAGE DEPARTbiENT OF [iEAI,TH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CI']RTIFICATES BASED _S_OLE'L_Y~ UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPIt 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER IiEGISTERED IN TIlE STATE OF ALASKA. THE DHEI? DOES Tills AS A CDURTESY TO PURCHASEi1S OF [{OHES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL A~D STATE REQUIRE- MENTS. EMPLOYEES OF DtlE~ DO NOT'CONDUCT INSP~,CTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. TIlE MUNICIP~(LITY OF ~]CttORAGE 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHEC, KLI~ - FEBRUARY 1984 A. W~]LL DATA Well Classification Well Log P~esent~N) Total Depth_ ,// '~ / ,__ Cased to ~ Depth of Groutinq Casin9 ~ight ~)~ Gr~nd. ~ Sanit~y ~al on Casin~ ~) _ Electrical Wirin~) in ~nduit ~) ]~essi~ ~ound Wel~ead (~ ~p~ation Distan~s fF~ ~11: To ~a~st ~ge of ~soFption Fieldgn ~t /O~ M~ ; ~ Adjoinin~ ~ts / ~/~ To ~est Public TO Newest ~blic ~ Line B® Standpi,pes _~N) Air-tight Caps .~/N) Foun, dat~on Cleanout (Y_Y_Y_Y_Y_Y_Y_Y_Y_~ , Pumping/Maintenance Contract on File (Y/N)~_~__; for--~-----_---~,' Holding Tark High-Water Alarm (Y/N) ~/~; ~l~a~y Holdi~ Tank Permit (Y~) ~ Sep~ation Distan~s ~(~ ~)ptic~Iding Tank: To Water-Supply ~1] //~ / To ~ilding Foundation ~--' ~ To ~o~rty Li~ /O /~, To Dis~sal Field ~ ~, /~, , __ To ~ter Mai~vic~ Li~ ~ To St~e~, Pond, ~e, ~ ~njor D~aina~ Co~s~ Counts [Pa~ 1 of 2] [ ~ ' 2~15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~_~/~ df width of Field / /~ O t ~ Square Feet of Absorption A~ea Depression over Field (~ Results of Last Adequacy Test ~ Type of System Design ~/]//J'r/~-~.]; Length of Field ~/~ Depth of Field ~ z Grail ~d ~ick~ss /~ ~' Stan~ims ~esent ~) ~te of ~st A~qua~ ~st~'~~ Separation Distanoe from Absorption Field: To wate -su ¢y , //'? To /0 '¥ TO Building Foundation ~d~ ~ To Existing or ~ndo~d System Lot ~/ ;~ ; ~ Adjoining ~ts TO Wate~ Main/~vi~ Line /L~O ~ To Cut~(if pre~nt) To Stre~ond~ke/~ Majo= ~aina~ C~se To ~'i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~ea LI~ STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) ConTents Dir~nsions Manhole/Access (Y/N) "Pu~p Off" Level at / / Vent (Y/N) >~/~es du=ing Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against }{AA ~%~quest I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. ~o~=,~ ,,r~H, 691 ~;'~ ' KB1/ds/s [Page 2 of 2] 2.-15-84