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Home My WebLink AboutT15N R1W SEC 9 LT 29B MUNICIPALITY OF ANCHORAGE DI- RTMENT OF HEALTH AND HUMAN SER, ..ES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~ame DISTANCES AL^$~,~ ~,q F'C 6,/ ~ SEPTIC ABSORPTION A~ TANK FIELD WELL ~- ~ ~j,~J~,~~ ~0T u,~ / o'~ /~'~ ~/~ Township, Range, Section ~8-aUILT DIAGR&M (Show Iocahon el well, septic system, property hnes, foundabon, TANKS - ~,utact~cr, /~ ~ O ~ Capacity In gallons TYPE OF SYSTEM Sm · ~~ L~TRENCH ~ED ~ W. DRAIN ~ OTHER L,¢T¢ ~ Depth to pipe bottom from Total depth lrom original grade original grade ~.~ FT ~ FT L ~(6~ot I~-- J~ol rabrlg Pipe material WELLS ~'~u,- ~ PRIVATE ~THER (Identify) (-/:~ ~ CiassIhC~ltlon (A,B C) ]otal Depth FT Cased to ~ / REMARKS: ~T , Inspections Pedormed by: . ............... cedify that lll~inspeclio~was pedormed according to all Eagle Rlver~ Alaska 99577 { / Health Department Approval: ' Date: ~~ . ' 72 013 (3/85) the [3 I:.a Le CC)ND Il). ) ,,- ,,/ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L ~)'~- ~,~/"~ DATE PERFORMED: Township, Range, Section: "~s/',,/, /~.(¥../,, ,-5~(:- ~/ SITE PLAN 5 6 7 8 9 10 11 SLOPE 13o 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? (~ p E Depth l0 Water ADer ~, Monilorlno? '? Date: Reading Data Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN __ FTAND __ FT COMMENTS '~?o:~4 Eaale Riv~ L~ R.d No. 2~ ~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI T ON THIS DATE. DATE: 72-008 (Rev. 4/85) 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 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) (c) (d) Property Owner /'~1¢~.~. /~/~.5. //~OT'"7-'Telephone: Home (¢,~g:,-~_..~./I Business Mailing Address Lending Institution.~'/'~-' '/-'g 5~' ~"~-"~' Mailing Address ~.0. ~ Reel Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ,E~'~old for pick up. List contact person and day phone number below. 17034 Eagle River Loop Read NO. 204 Eagle Klver, Alaska YY317 2. TYPE OF RESI.~D~F~ Single-Family ~ Number of Bedrooms WATER SUPPLY ~ Individual Well [] Community [] Public Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Onsite Cai' 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 tF~v 8/861 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 inspect[on, the on-site water supply and/or wastewater disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ & 5 ENGiNEERiNG Address 17034 Eagle Rl~e~ L~ Roa~l No, 204 legJa Rlver~ Alaska ~9577 Date Telephone DHHS APPROVAL Approved for ~ ~"~/~ bed rooms by ~;;;~,~--~ ~O' '~'~TM Approved Disapproved Conditional Date Terms of Conditional Approval 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 DHHS 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 IRev 8/86/ Back OF ^HOIO'~^6I~UNICIPALITY OF ANCHORAGE (MOA) MUNtC. IPALB'Y ..... , TS OIVI~LTH AUTHORITY APPROVAL (HAA) ~NVi~ON~NT~ CHECKLIST - FEBRUARY 1984 264-4744 K 2 4 1987 Legal Descdptiom ~ ~ RECEIVED If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level 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 ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer CleanouVManhole To Nearest Sewer Service Line on Lot 7-z~' ]-cc Water Sample Collected by ~Q~ ,~F- ~ ~../.J ~ ~ ,~./~"~.~l ~ C~ ;Date Water Sample Test Results 5 "q'~'/~'/-~'J~Y' /~''' /'~U~E'~'~ ~ /'~/~' Comments B. SEPTIC/HOLDING TANK DATA Date Installed ,,~'x', /5~~' Size"'~/5~;~ /~- No. of Compartments ~ Standpipes~) Air-tight Cap~N) Foundation Cleanout (Y/~ Depression over Tank (Y,~ Pumping/Maintenance Contract on File (Y/N~,~ Holding Tank High-Water Alarm (Y/N) /./~ Separation Distances from Septic/Holding Tank: Date Last Pumped c¢~ - l, '~ -- 0 7 ; for Temporary Holding Tank Permit (Y/N) To Building Foundation !"~ ! To Disposal Field / ~ f' To Stream, Pond, Lake, or Major Drainage TO Water-Supply Well To Property Line To Water Main/Service Line Course Comments ~ Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Type of System Design~*¢1~¢ I~-~ Length of Field ~ / Depth of Field ~ ~ Gravel Bed Thickness O. % Standpipes Present (~N} Date of Last Adequacy Test t'4/F~ ~ /~ ~'~'( To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~.~ I4' To Cutbank (if present) Depression over Field (Y/~.)~_ Results of Last Adequacy Test _ 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 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at _ High Water Alarm Level Tested for ~/~ Electrical Codes ~N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at .2' ~ '~' 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 MQA and HAA guidelines in effect on the date of this inspection. Signed $ & $ ENGiNEE~,ifiiG (,., / Co m pa~34 E~le R~ Receipt NO~ Date of Payment Page 2 of 2 72 026 (Rev 8/86/ Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 INSPECTION APPOINTMENTS ~.~ ~_.,/~., DATE DATE /DEPT. OF H~ALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENT~ PRO'rE~ION! DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ ENV, RONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ -~ P ONE MAI LIN G ADDR ESS MAILING ADDRESS - LEGAL DESCRIPTION ;TREET LOCATION TYPE[ OF RESIDENCE NUMBER OF~BEDROOMS [] One [~ Four 1~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other~ 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY PUBLIC UTILITY * 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.) SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SIYE** [] PUBLIC UTILITY 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 NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE ~ [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM ~ERMIT NUMBER [] iNDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line [ Nearest Lot Line WELL TO: I Absorption Area to nearest Lot Line 5. COMMENTS [~APPROVED FOR ¢~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~ DATE BY ~'~C 72-010 (Rev. 6/79) DAVID A. SLENKAMP MECFIANICALENGINEER 694 9055 July 1, 1980 ROBERT A. SRAFER CIVIL ENGINEER 694-2979 Ms Kathy Blair P~O. Box 16 Chugiak, Alaska 99567 Reference: Lot 29B; T15N; R1W; Section 9; SM Dear Ms. Blair, At your request a sewer system adequacy test was performed on the system located on the referenced property. The septic tank was pumped and verified to have a capacity of 1500 gallons. At some time in the past the absorption area had been upgraded with the addition of a trench tied into the existing seepage pit~ The seepage pit was filled with water and 778 gal]o~s of water was added to the trench by continuous flow over a period of 24 hours without any measurable rise in the sump st the end of the trench. It can be concluded from this test that the functioning adequately for the four bedroom on this property. If we may be of to ca].].. sewage system is residence located further assistance, please do not hesitate 2~/~Since- ly, ~ h. cc: Great ~and Realty ATTENTION: Mary Ann National Bank of Alaska 'Municipality of Anchorage Department of Health and Enviornmental Protection SRB 196X EAGLE RIVER, ALASKA