HomeMy WebLinkAboutT13N R1E SEC 10 N2NE4NW4SW4
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
NAME PHONE ~NEW
~ ~/5~_../~. ~.~~ ~'{~'~- ~ C~O ~ UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
]WIJ Absorptio~ area Dweiling I PERMIT NO.
DISTANCE TO: I T 0 /
~ ~ Manafactarer Material No. of compartments
Liq. capac[W in galJo~s Inside ~ Width Liquid depth
[ ~ IF HOMEMADE: ~ ~
~Oz~ ~ DISTANCE TO:well ~/~ Dwelllng , ~ -~ PERMITNO'
O ~ ~ Manufacturer Material ' Liquid capacity in gallons
9 Well I Found~o~ ) Nearest lot I~n¢ PERMIT NO.
Trench wid ~ Distance hetwee~ I~
;~ ~ ~o. of lines) Length o~h~ ,ine Total ,.~>,,~ "-~. ~ i=?.L. Tota, offoct~o~--/~
~ inches
~ ~ Type of crib Crib diameter -Cr depth Total effective absorption area
m ~oll B n~ ~oundation ~earost lot
m DISTANCE TO:
~ C~ De~ h Driller Distance to lot line PERMIT NO.
m ~ ' ' ' ~ Bui ~ ~oundat[on Somor lino Septic tank ABsorption area(si
PIPE MATERIALS
SOILTESTRATING[~ ~- - /' ~ ~
~.Od EO0 ~O:BO
DEPARTMENT OF HEALT'H AND ENVIRONMENTAL PROTEDTION
825 L] ST'REEl's, ANCHORAGE, AK 99501
264-4720
PERMI]- NO: 8,,~ ,.76
I'TA"FE ISSUED: 09 / 10/85
APPL I CANT
ADDREESS:
CONTACT PHDNE:
BARBARA NEESER
% S&S ENGINEERING
EAGLE RIVEER, AK 99577
694-2979
GRAVEL DEF:'TH (F'I".)
TOl'AL DEPTH (F'T.)
.GRAVEL WIDTH (F'T.)
GRAVEL LEI"4GI"H (FT'.)
GRAVE(.. VOLUME (CU
TANK SIZE (GALS)
SOIL RATING (SQ~F3-. /BR)
LEGAL DESCRIF': SUBDIVISION= Ni/2~NE1/4,NW1/4 LOT: SW1/4 BLOCK: NA
SECTION: 10 'I-OWNSHIP: 13N RANGE: 1E
Lei' SIZE: 217800 (Se. FT. OR ACRES)
MAX BEDROOMS: 3
.Listed below ape the optic~ns available t.o you in designing youP septic
system., Choose the opt. ion {ha{ best. ¢its youp site.
DEPT'H TO PIPE BOTTOM ~FT.) 4.0~/
5.0~-
9.0
45.0/' '
1,00C). 0
150
4. ID ¢ 4.. 0
0.5 3.5
4.5 7.5
J. 9,, 0 5,, 0
36.0 4.9.0
25 ~ 4 36.3
I, 000. O. ~'~ 1,000,, 0 '~'~
150 150
'x~~' 'rFANK MUS'I" HAVE: AT LEAST TWO COMF'ARTMENTS
I certify that:
1. I am'£amiliap
2.
;~;.
with the pequir'emeets' for on-site sewers and wells as set
fopth by the Municipality o£ Anchonage (MOA) and '(he State oF Alaska.
I will install the syst. em i*n accondance wi't.f~ all MOA cedes and pegulatiens,
and in cc)mpliance with the design cniter'ia of this pem~it.,
I Wi].]. adher, e to al..1 MOA and State eF Alaska requirements fep"t, he set.. back
distances Fpem al'ly existing ~.~ell, wastewat, en disposal system or public
sewerage system en t. his on any adjacent op near'by lcTL.
I undenstand that t:his permit is valid £o~ a maximum of 3 bedneoms arid
any enlapgement will require an additional permit.
IF A LIF'T .~]A~ION IS ..NS FALL. ED IN AN AREA COVERED E¢ MOA EUILDING CODE:~
T'HEN (1) AN ELEC]-RICAL F:'ERMtT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT E~: AF'F:'ROVED Wi'I"HOUI' AN ELECTRICAL IN.~FE. CII[]II REF'[]F~'T~ AND (3) THE
ELECTI'~ICAL WORK MUS'T' BE DONE BY A LICEIBED ELEC. TFd. CIAil.
:(SE;LiED I~:~Y~~ ~ ' /~ DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
B2B L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3-
4
5-
6-
7
8
9-
10-
11
13
14-
15-
16-
17-
18-
19-
20-
COMMENTS
SLOPE
DATEPERFORMED:<~-'"~'~>,~
SITE P
WAS GROUND WATER S
ENCOUNTERED?
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND -- FT
PERFORMED BY:
CERTIFIED BY:
DATE:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Nb; NE~; NW~; SW~; Section I0; T13N; RIE; SM
Location (site address or directions)
2405 Eagle River Road, Eagle River, Alaska
Property owner
Mailing ~ddress
Lending agency
Mailing address.
Barbara Ne~s~r Day phone 277-2580
2405 Eagle River Road, Eagle River, Alaska
Day phone
Agent
Address
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
TYPE OF~WASTEWATER DISPOSAL:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
., lng to the legality and status of system.
Individual on-site ~(~
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72 025 (Rev. 1/91) Front MOA #21
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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
Engineer's signature
$ &-S-ENGINEERING
17034 Eagle Rivet' Loop Road No. 204
Phone
DHHS SIGNATURE
X Approved for
~",~,~Y~-,,)b ed ro o m s.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By: ....
Date
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.
72~)25 (Rev. 1/91) Bsck MOA #21
Legal Description:
A. WELL DATA
Welltype
Log present(~YN)
Totaldepth
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
If A, B, or C, attach ADEC letter· ADEC water system number
Date completed ~- t ~-~ Driller
Casedto ~ ~ ' ~
~ Casing height
Sanitary seal~'/N) y "'"' Wires properly protected~YN)
FROM WELLrLOG AT INSPECTION
Static water lever ~' ~
Pump leve~ ~) ~, 0~
SEPARATION DISTANCES FROM WELL TO: ~ ~ ~ ~% ~
Septic/holding tank on lot
Absorption field on lot t. ¢2~' t
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manho e/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform (2 C °"~/t¢0~,~, Nitrate
Date of sample: ~ ~ ~J ~'~ ~' Collected by:
Other bacteria ,,'J "~,'J~
S & S ENGINEERING
17034 Eagle River LOOp Koaa ~'~. ~
Date of pumping ·
Eagle River, Alaska 99517
B. SEPTIC/HOLDING TANK DATA
Date installed : .~t~/ ~ ~" [Oc, C.~ ~
·. .". Tank size Compartments
Cleanouts~C~'N) ~' Foundation cleanoutb~N) 7 --'~ Depression (Y/~)
High water alarm (Y,~ /'J Alarm tested (Y/N)
~'-'~ ??"~ Pumper ...T.I~,
SEPARATION DISTANCEs FROM sEPTIC/HOLDING TANK TO:
Well(s) on lot ~ '¢"~ ~ -~' On adjacent lots t c~o ~ 4- Foundation_
Topropertyline /o ~ ~' Absorption field lc;, '
Surface water/drainage I P~
wate?main?setvice line
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA elec~
Manufacturer
Manhole/Access (Y/N) ~
"Pump on" level at .~'"¢~ump off" level at
-~~Gycles tested
Surface water
D, ABSORPTION FIELD DATA
Soil rating i, ~- C~ I~l~ System type "~F---6.~/.~
Date installed
Length ~ ~"~ Width
Total absorption area ,¢¢5'-0 '¢ '"'
Depression over field (Y~
Result~ail)
Peroxide treatment (past 12 months) (Y~:~)
If yes, give date
Gravel thickness ~'
Cleanouts present ~Y~N)
Date of adequacy test
for '~"'¢~¢"¢-~_¢.
Total depth '~ *'~'
bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1. '~"¢ ~
To building foundation
On adjacent lots '~:;~
Surface water t, c, c, ~ i--
Curtain drain ~J~
E, ENGINEER'S CERTIFICATION
On adjacent lots ~ c~ ~ ~ '~' Property line
To existing or abandoned system on lot
Cutbank ~ I~ Water main/service line
Driveway, parking/vehicle storage area
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
S & s ENGINEERING
17034 Eagle River Loop RoadJ No,
Signature ...........
Engineer's Name
Date ~ ~ ~'~'
jo~4-
;ct o~,~ date of this inspection.
HAA Fee $
Date of Payment o~ - \ ~-<~ ~
Receipt Number
72-026 (Rev. 8/91 ) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number