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HomeMy WebLinkAboutT15N R1W SEC 9 Lot 24A 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 ME LEGAL DESCRIPTION LOCATION ~'OT' DISTANCE TO: I Well iAILING ADDRESS Manufacturer DISTANCE TO: No. of lines IF HOMEMADE: Well Well Length of each line Top of tile to finish grade DISTANCE TO: Width I Crib diameter Depth~ Building foundation IAbsorption ar~_¢~ I~/, Inside length f~ndation al length of lines ~V/~terial beneath tile PRONE /~NEW E]UPGRADE Dwelling 13 Material Nearest lot line Trench width Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines inches Total effective absorption area inches Total ef fective absorption area ~,~0~) ~ Nearest lot line ~'~ I~ Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PiPE MATERIALSp VC SOIL TEST RATING /~O¢j~/¢__/ REMARKS 'To APP~ D 72-~3/Rev. 3/781 DATE LEGAL / / ermit ~ ~ICIPALITY OF ANCHORAGE Dep~rtme~t o~ Health and Environmental otection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT ~plicant: ~ S ~ Mailing Address: ~.qcation: ,egal Description: L Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: Phone Number: Lot Size: Seepage Bed: t--~ Holding Tank: Soil Rating(sq.ft/br) /S~ The Required Size of the Soil Absorption System Is: DEPTH, ~-~' LENGTH ~ ~ GRAVEL DEPTH ~o" 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 = /dO ~ GALLONS * * 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. * * * 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. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 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) Signe~: and wells as I understand that the on-site sewer the~esidence ~/~eled to A-~cq~. ,/I/~Z.~ Applicant '"-~' system may require enlargement include more that 3 b~ooms. Issued by: ~ ~ Date: ~//~k~ / ~ if SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /~ SOILS LOG [] PERCOLATION TEST DATE PERFORMED: 3 L.I&W'~' 51bT 5 6 8 9 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BET~/EEN ~f'/~ (minutes/inch) FT AND -- FT PERFORMED BY: ~B 19BX 72-008 (6/79) OOC Co. SULLIVAN WATER WELLS P.O. BO)~272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 ~ Il O~NEROFLAND~n'"JO Y ~,.',r~,~,~'_,4q ~ D~,T. OFWm I 6o ~ LEGAL DESCRIPTION PERMIT NUMBER DRAW DOWN FT. GALS, PER HR __.~& 0I~O KIND OF FORMATION: From 0 Ft. to.--~--Ft, ~')~'~ ~'~'"J~ From ~ Ft. to .~C Ft. ~"t~'~ ' ._ From Ft. to Ft. ~'~" ~"1 ~' ~'~- From Ft. to FI From Ft. to Ft. From Ft. to Ft. From Ft. to Ft.. From Ft, to Ft Frmn ..... Ft. to ..... Ft, ~ ~,~C ~.. From .... Fi. to ~ ~'fflf~ From_ Ft. to ...... Ft. From Ft to . Ft Fron~ Ft. Io FI 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 From .... Ft. to ..... Ft. From _Ft. to_ Ft. From Ft. to Ft. From ..... Ft. to _Ft. From .......... Ft. to Ft. a M1SCL. INFORMATION: DRILLER'S NAME -, - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION DIVISION OF ENVIRONMENTAL HEAL'FH OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ,- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name //,/UZ)f~ ,/'~_z3Z~Z/'2 Telephone: Home Business Applicant Address /~'~' ~'O~ ~.~ ~. ~ (c) Applicant is (check one): Lending Institution []; Owner/builde Buyer []; Other [] (explain); (d) Lending nsttutonJ~'/~,~/,,/~/j ,~¢*'87-~'-~-' Telephone Address ~ ~, (e) Real Estate Company and Agent ~ ~ ~ Address Telephone (f) Mail the HAA to the following address: 17034 Eagle Rl~er Loop Road No, 204 Eagle River, Alaaka 99577 TYPE OF RESIDENCE Single-Family~ Multi-Family%:~ [] Number of Bedrooms ~ Other WATER SUPPLY Well~ Community [] Public [] Individual Note: If corn m unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsitex 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. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIr., ~ INSPECTIONS, TESTS, FILE SEARCH, ~..rA 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 S & $ ENGINEERING Address ~ 7034 E-'C!' ['!"~" [ '"%" ~-~-'~ H=. 204 Date Eagle River, Alaska 99577 Telephone / / DHEP APPROVAL Approved for ~'~"~"~'"~ bedrooms By ~ Approved ~ Disapproved '~"~"~'~ Date 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 72-025 (11/84) Mb*,,CIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (NAA) JUN 81987 CHECKLIST- FEBRUARY 1984 264-4744 Legal Description: L o F P~ [~,~/~-~Jd-,V~E,/J~,~ WELL DATA Well Classification Well Log Present~N) Total Depth /f~,~ Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Condui (Y~) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed ~ ~,¢ ,E~ Yield /,'-'~ Depth of Grouting /~ Pump Set At .~c," Sanitary Seal on CasingS/N) Depression Around Wellhead (YN~ To Septic/Holding Tank on Lot //~:/ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot //.'-~'~ On Adjoining Lots To Nearest Public Sewer Line /'""/.'q To i~learest Public Sewer Cleanout/Manhole ~/,'~ To Nearest Sewer Service Line on Water Sample Collected by ~ .¢-,~ ~.,,./~/.,,./¢=~_..-¢~1,.,zc. ; Date WaterSampleTestResults ..~',;¢~ ~'~/.,~l~¢"r'ol'z.~. ~-o ~ B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes(~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/.N~! ~//4 Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: ~) ' ~- - P~$ Size / g--Co No. of Compartments Air-tight Caps ~_~N) Foundation Cleanout~N) Date Last Pumped ,~- - Z. ~ -,~ ~. ;for Temporary Holding Tank Permit (Y/N) 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 1 of 2 72-026 fRev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ 'Z~- Width of Field Square Feet of Absorption Area ~ Depression over Field (~/~ ,~'/~-~ Results of Last Adequacy Test ,~.,~-~-/,¢,¢",,,¢¢.4~'¢~ 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 Comments ~"~f"~ cz/ .~'/'~=,.,~ ,~c/~' Type of System Design Length of Field ~ Depth of Field ~- ' Gravel Bed Thickness / ' Standpipes Present~..~/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~¢5 ~/T~,/~utbank (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) 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. Signed $ & ~, .%%,G I ,~; .~ _~ = l,~;C Date Company 17034 Eagle River L~ Red ~8~o. Eagle Rlver~ Alaska 995~ Receipt No, ~ ~O /- Date of Payment ~ ' ~ ' ~ ¢ Amount: $ ~O ~ Page 2 of 2 72 026 trey 81861 Sack CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ~.~" X 5633 S STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~,~ :~;an}p i e ~'ec' ct : OON Z ~ ;' iJcdered ~y : Ui,5[HOWf~ L/Ob4 6aG]:i: J~fVER LO0? RB,. ~204 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY 264-4744 H86-i400 AMENDED Application Date 12-19-86 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legat Description (include lot, block, subdivision, section, township, range) Lot 24A, Section 9, T15N, R1W, S.M. Location (address or directions) Property Owner RAndy ¢,m~neau Telephone: Home 688-4423 Business Mailing Address P- ~- Rr~x R7f}90/, Chuglak_. Alaska Lending Institution Northland Mortma~e Telephone Mailing Address Eagle River. Alaska Real Estate Company and Agent _ Linda Ballard/Greatland Address P.O. Box 633. Eagle River. Alaska Telephone 694-9125 ~cthe HAA to the followinc~ address: or: Check here [~X, if hold for pick up. ontact person and day phone number below, (b) (c) (d) (e) TYPE OF RESIDENCE Sing[e-Family ~ Number of Bedrooms WATER SUPPLY Individual Well I~ Community [] Public [] Note: Jf corn m unity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note; If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/86) Front 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 Telephone Address Date ENGINEER'S ORIGINAL STAMP AND SIGNATURE ON FILE WITH DHHS Engineer's Seal DHHS APPROVAL ~pc~al ~-wn(?) bedrooms by '~ ~cu-~' Date March 25. 1987 Approved Disapproved Conditional 'XX'X Terms of Conditional Approval Existing system must be upgraded bv June 15, 1987. 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 8/861 Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL /~/~/~ ~ ! L/~_~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~D'//~/ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) (d) (e) (f) Applicant Na~lephone: Home _/~_~ - '/-'/5/,=;- ~ Business / ' / Appl~t iS (check one~ Lending institution D; Owner/builder ~; Buyer~; Other~ (exp ain); Lendi~olnstitution~~ ~'¢~-, Telephone ~ ~he HAA to the following address: TYPE OF RESIDENCE Single-Familyx Multi-Family [] Number of Bedrooms Other 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.~ 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. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~A 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 inspect[on, 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 C J~ ¢ Address ~g R 1._~6.~'' Date EAGLE RIVER; AK Telephone / 6. DHEP APPROVAL Approved for '~- ' ~ bedrooms by Approved .~ ~ ~ Disapproved Terms of Conditional Approval T~ o~ THE P~/~ Conditional 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 72-025 (~ O%~,~UNICIPALITY OF ANCHORAGE (MOA) , h~ , ~. I-I~F~LTH AUTHORITY APPROVAL (HAA) ,~ ~O~TO~C~'\u' CHECKLIST- FEBRUARY 1984 ~.~1\~3''' ~l,Ob'~'~ Legal Description: WELL DATA-¢'(" . I~.,,~.C~.~,,.'~ Well Classification ~,~, If A, B, C, D.E.C. Approved (Y/N) Well Log Present(~N) Date Completed ~:'-~ ~ ~"~ Yield Total Depth linc)' ~5" Cased to Static Water Level I~f'"~ Casing Height Above Ground Eledtrical;Wiring in Conduit~N) Separation Distances from Well: To Septic/J:~d~r'g Tank on Lot Depth of Grouting ' ' - Pump Set At 01~ Sanitary Seal on Casing,~N) Depression Around Wellhead (Y/~) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot \ ~ .~ i ; On Adjoining Lots To Nearest Public Sewer Line '51~' To Nearest Public Sewer Cleanout/Manhole P/~' To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~ ~-~ ~C:~G (r~-,~ll,--..~ ; Date ~"~' ~ ?~'/~ Wa.t.e~ampie Test Results ~"I~'~ B. SEPTIC/I-I&N~NNG TANK DATA Date Installed "~-~?.~"5 Size Standpipes~)N) Air-tight Caps ~N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) j Holding Tank High-Water Alarm (Y/N) I~/,~ No. of Compartments Foundation Cleanout t~N) Date Last Pumped ;for - Temporary Holding Tank Permit (Y/N) h.5/~ __ Separation Distances from Septic/~g Tank: To Water-Supply Well To Property Line To Water Main/Service Line, Course Comments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) 72~025 (Bev, 3/9 Back MOA 2 ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~A 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 inspect[on, 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 ¢ J~ ¢ Address ~g R 1._~6.~'' Date EAGLE RIVER; AK Telephone / 6. DHEP APPROVAL Approved for '~- ' ~ bedrooms by Approved .~ ~ ~ Disapproved Terms of Conditional Approval T~ o~ THE P~/~ Conditional 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 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed -"/ Width of Field Square Feet of Absorption Area Depression over Field (Y/4~ Results of Last Adequacy Test Separation Distance from Absorption Field: Type of System Design Length of Field ,~.~ Depth of Field ~-~ Gravel Bed Thickness I Standpipes Present ~N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation ¢,/J~ Lot To Water Main/Service Line ~ ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots '"&c:> I..~ To Cu~tbank (if present) ,12 D, LIFT STATION Date installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at High Water Alarm Level at Tested for "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) 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. Signeds & S ENGINEERING Date SRB 196X MOA No. C°mPaI'~GLE RIVER, AK Receipt No. ~1/2'~1~ Date of Payment Amo.nt:$ Page 2 of 2 72-026 (11/84)