HomeMy WebLinkAboutT15N R1W SEC 18 LT 209
~=~- MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
{ ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE [] NEW
~,~'~l~ ~ .~ ~1~ ~0~ ~, ~-~ ~ ~ ~UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
IWelI ] Absorption area Z / Dwelling PERMITNO.
i~~ Msnu~acturer ~¢~ Materia~
Liq. capacity ~n gallons InsMe length Width ~ Liquid depth
/o~+ ~OO IF HOMEMADE:
~ ~ DISTANCE TO: Well DwelHng PERMIT NO.
~_~O ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation ~ / Nearest lot line ] ~-- /
~ DISTANCE TO: }~¢ PERMIT NO.
No. of lines
Length o~ each line Total length of lines ~ Trench width Distance between Hnes
~ ~ ~ Top of tile to finish grade / Materia) beneath tile Total effective absorption area
o. ~ 7
OTHER
/ ~o ~ ~ ' ~
72-013 (Rev. 3/78)
D!EPAR'I"MEi]xlT' OF::' t'IIEAI..]'H AND E:NVIR[]I'~!I'!IEN'TAI..
EI25 L EYT'RE]ET~, AtxlCHE1RAE;E:, AK 9950:1.
264 "' 'q 720
DA TT!'. 1 ~.,x. UI....I .... ()~.:~ /()4 /85
9956 '7
(::: e r' 'L :i. '1' y 't,. I't a t:
Fi::lPt, h I::!y i;l"i,:i~ Mt, u"t;i.c::i.t]a].:i, tv Eli' ~l]Eil']c)r'aEl% O'"IOA)
2. I v4:i.l:l. :i. nstal]. 'Lhe iEiyEitE.xil J. li &tC:[;:C.H"CI.f':U'IE.E¢ w:i.'L!'~ a:l.:l MOA (:::(::l(;:lt;:~!~i ar]:::l r,:.~:gu:l, at.:i, cx'::i:i,
3., I w:i. ll adhere 't:~::~ a].l MOA anti State o.F A].aska
I r::' A
TI. IEN
W]:{..L. NOT' BI!!: AF::'Fr:q::i.'OVED W:['T'I.I[]!JT AI',I IEt...IEC"H::i:ICAI
tEL. IECTF';IICAL W[]RK I"I!JS]' BIE ,~:)OhlE: ):Iv A I,ICE:
,qlq iq F:/I!!:A
:!: NSF'E:C T ]: lIN MI..fST'
]; SSt..IED
-~ MUNICIPALITY OF ANCHORAGE
(~'e~~ DEPARTMENT OF HEALTH & ENVIRONIVIENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
' 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
.... [] UPGRADE
LOCATION NO. OF BEDROOMS
~ I Well ~ ~ Absorption area f Dwelling PERMIT NO.
DISTANCE TO: ~, ~ __~
Material ~o. of compartments
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufa~r-~'; ..... Material ~qu]d capacity in gallons
~ DISTANCE TO: Well ..... Foundation Nearestlotli,le~ t PERMITNO. '~/~¢¢¢1
No. oflines ~ Length of each li~ , Total length oflineb~, Tronchwidth Distance between lines ~/~,
~ Top of tile to finish grade ~ ~ Materiel beneath tile ~ ~ ;nc~¢s Total effectiv~ absorption area
Length Width Depth PERMIT NO.
~ Well Building four~tion Nearest lot Hne
~ DISTANCE TO:
~ C~ass Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer Hne Septic tank Absorption ar~s)
o~ _ '_/~ ,~,~/,
MATERIALS ~ ~
SOILTESTRATING /~ ~, ~ ~ , ~ ~
INSTAELER
~_ _ ,.i,_.. _ .~J~._ .
f ~,,~,
/
72~ 13 (Rev. 3/78)
z
�. 11" PTI Oil 0" 1" 1" 1" ot021 v
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oil
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Oil It 0 1"
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F'ERM I T blO.
f~IPPL. IC:FINT RF/LPH H. MOODY
LGCI:~TION SF'RLICE C:REST DR.
I_EGF:IL LOT 2¢':'? SEC: :t. 8 T:I. 5N R:LN
T'¢PE OF:' '.:..;OIL,. FIB'50RPTION SYSTEM I5;:
MR',4IMLIM NLIMBER OF E:EE:,ROOMS =
TFIE REE.:!UIRED '.:..;IZE GF THE SOIL FIBSORF'TION S'¢STEM :IS:
TNE LENGTH DIMENSION IS TNE LENG'rH <IN FEET) OF TNE TRENCIq OR DRRINF:IELD.
]"HE f:)EPTH OF' FI TREi',ICI..,i OR PIT IS; THE DISTRNCE BETHEEN TFIE St.IRFI::IE:E OF TNE
GROUND RND ]"FIE; BOTTOM OF THE: E',:.::CR'v'RTION (IN FEET).
'T'HERE IS i'40 SET HIDTFI FOR TRENCHES.
THE GRFI'v'EL DEPTN IS THE rItNIMLIH DEPTH OF' GRRVEL BETHEEN THE OUTFFILL P:[F'E
RND THE BOTTOM ElF THE EXCRVFITZON (IN FEET).
H[~.., TNE RE_,FON- IE Il_Il ~ INFORN l HI.,., E:,EF'RRTMEN'r EI..I~,II,~-~ THE
PERMIT FIPF'LIC:FINT "': ' ::'" ':'- '" "' l'O '' ':' ..... ' ' f'
IN5:TRLLFITION INSF'EC. TIONS OF FIN"r' HELLS R[:.3FICENT TO THIS F'ROPERT'¢ FINE) THE
NUHBER OF RESIDENCES THFIT THE HELL HILL SERVE.
.................. 'T l...I C) ( ;;?. ) I I'-,I :',E; P E.:. C.': T I ~::l t'-,t ~'~_; IF:l I[;~'. [E [~ E E,;'~ LI I ~;: E FZ:,
DFIC:KFZLt. ING OF FIN'T' 5;'¢STEM H[THOUI" FINFIL. INSPECTION RN[:, F. IPPF:'.O',,¢FIL B'¢ THTS
[)EF'FIF~'.TMENT HILL BE ~:;IjE:,)ECT TO PROSECUTION
PIININIJN DISTRi',,ICE BETHEEN FI HEEL FIND RWr' ON-SITE SEHFIGE DISPOSFIL SYS',TEH ]:S
:1.00 FEET Fi:iR FI PRI',/FITE 1.4ELL OR :'LSE'~ TO 2OC~ FEET FR. OH F! PUBLIC HELL DE:PENDING
UPON THE T"r'PE OF PUBLIC 14ELL.
MtNIMtJfd DISTFtNCE F:ROM FI PRIVF'ITE HEt_L TO FI PFtI'v'IaTE SEHER LINE :[5; ;2.5 FEET FIND
TO F:I C:OMMUN:[T'¢ SEHEP:: LINE IS ?rS FEET.
HELl._ LOGS taRE REL::!UIREI:::' FHqE:' MUST DE RETtJRNED T'O THE DEPFIRTHENT H:[THIN ZE~ DR':,",.',:.;
(:iF:' ]"FIE HELL COHPI_E, T ION
OTHEF: REEQI..IIREMENI"S MR"r' F~PPI..,."¢. SPEC:IFICRTIONS FIND CONSTRI..ICI"ION DIRGRRi"I::-:; RRE
Ft'v'FIILRDLE TO Zi",ISURE F'ROF'EF~'. ZNS;TlaI_LlaTION.
F:' EZF~:f-1 ]: T' E"Z.":< F" ;[: i:~:D;:~; E)E:C:EI"IE"'E:Z[;~" 3::1_,,
I CER'rIF"r' THRT
:1.: I FIM FFIf'1tLIFIR b.I]:'TI'-I 'rile REQUIREMENTS FOR ON-SITE SEHERS FINE) HELLS RS SET
F'ORTH B'.? TNE PlUNICIPRLIT'¢ OF FINCHORRGE.
2: I 14ILL INSTFIL,L THE S~r'STEM ];N FICCORDFINCE HITH ]"FIE CODES.
2: I tJI'4[)EiRSTF~N[;)THFFf' THE ON-5;ITE SEHER 5;'¢'.5TEH i'IR'~' REg!UIF'.E ENL, FIF:GEftENT IF' "FHE~\ ~^
DE"L";:[I)EHCE IS RE:MO[:,ELED TO INCLLiDE HORE TI-IFIN 5: E:E[¢RI:)OHS, N .c~,2e~
''"~~C',
FtF'F'L/~J.':Ft~q; RFILF'H P.I,,,~'~K)OE:'"r' ~ \;~t "~ ~o (~'"'-
....... X-?'-'* -/ ...... .I.
O & E ENG,NEERING & DEVELOt ,vlENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Ru,,sell Oyeter
694-2774
Performed for:
5__
6__
7__
8__
9__
10__
.... .11 __
12__
13__
14__
Legal Description:
Depth (feet)
Earl Ellis
SOIL LOG 688-2280
Name: ~/~/~, ~3~,j /d~Oc~f T611 mo.~' ~¢
Mailing Address', ~ /~ ~2~ '/'"~ ~ &~O'~ J~ r ~7
-/
$oll Characterlatlca
PLOT PLAN
PERC. TEST
Ground Water Encountered: Yes No ~ If yes, what depth
Proposed Installation: Seepage Pit Drain Field ~
Performed by:~~ /)~' ~_
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block,
Location (address or directions)
(b) Applicants Name ~-~c~
Applicants Address ...~
(c) Applicant is (check one) Lending Institution
(d) Lending Institution
Address
subdivision, section, township, range)
~-97-~}
Telephone - Home Business -----.
Telephone
(e) Real Estate Co. & Agent
Address ~*~ ~
(f)
Telephone
Mail the HAA to the following addrese:
2. T~pe of Residence
Single-Family~
Number of Bedrooms
3. ~ater Supply
Individual Well~
Multi-Family~--~
Other (describe)
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
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]
5. Ensineerin~ Firm Providin~ 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 regula-
tions in effect on the date of this inspection.
Name of Firm ~/~ ~ ~z-/¢~^~/ /~,~'~ Telephone O .7)~- ~'~/~
Address ~ ~ ~.~/ /~-~.4 ~- ,~) ~ /9 ~ ~,~¢_~'(~ ~/~ ~P~/
DHEP Approval
Approved
(ENGINEER SEAL) ~':~. ~c ~'.' . ..~ '.~
~,.,~_... .. ...... .,.'" ~./. ;
~ sappr ~ tion~ ~
Di
oved
Co~
i
Approved
Terms of Conditional Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AM INDEPENDENT PROFESSIONAL ENGINEER REGI~"EP=n
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES ~ND
THEIR I~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. ETiPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. TflE MUNICIPALITY OF ANCRORAGE 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)
CHECKLIST - FEBRUARY 1'984
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTIOt~
RECEIVED
Legal Description:
~LL DATA
... ~a c . I ~r T /~-~ ,e z ~/
Well Classification ~l¢~r~- If A, B, ~ C, D.E,?/,._ ~°~d(Y~) ~
~ll ~ ~esent (Ye) ~ ~te ~le~d ~¢/¢ ~/ Yield
~Z/~o' ~dDto ~¢ ¢ ~pth of ~ting ~/~
Total
~p~
Static Wate= ievel '~ ~ .~- Pump Set At
Casing Height Above Grcund
Electrical Wiring in Conduit (Y/N)
Separation Distancss f~cm Well:
To Septic/Holding Tank on Lot /OO '~-
To Nearest Edge of Absc~ption Field on Lot
To Nearest Public Sewe= Line
Sanitary Seal on Casing (Y/N) ~'
Sep~ession A~ound Wellhead (Y/N) ~/
; On Adjoining Lots /~J
/~- ; On Adjoining Lots
To Nearest Public Sewer
Cleancut/Manhole ~/~
· ,./
Wate~ Sample Collected By
Wate~ Sample Test Rssults ~'~,~ ~.~F~.? --
To Nearest Sswer Service Line on LOt -~ ~- ¢'...
B. SEPTIC/HOLDING TANK DATA
Date Installed /~t Size /~ 6'-(/ No. of Cc~a~tmsnts
Standpipes (Y/N) / Aid-tight Cape (Y/N) ~/ Foundation Cleanout (Y/N) /,V
Dep~ession over Tank (Y/N)~/ Date Laet ~umped
pumping/Maintenance Contract on File (Y/N) /~'//~, for
Holding Tank High-Water Alarm (Y/N) /////~ Tempora],,y Holdir~ Tank Permit (Y/N)
Separation Distances f~cm Septic/Holding Tank~
To Water-Supply Well
To P~ope~ty Line /~)
To Weter Main/Service Line
Course /~/~
TO Building Foundation /d~Y-
To Disposal Field /2% /
To St~e~, Pond, Lake, c~ Major D~ainage
Corm~nts
[Page 1 of 2]
¢-C', ~o% Iq%
2-15-84
C. ABSORPTION FIELD DATA
soils Rating in Absorption Strata
Date Installed /f~c/
width of Field ~/t
Squa=e Feet of Absorption A~ea
/~-O ~ Type of System Design
Length of Field '~ ~/
Depth of Field / / '
Gravel Bed Thickness 7 ~
Standpipes Present (Y/N)
Depression over Field (Y/N) A/. Date of Lest Adequacy Test
Results of Last Adequacy Test ~ ~ ~ c/-~.;
Separation Distance frc~ Absc~ption Field.'
To ~ter-Supply Well /~90 ~- To Property Line /~f-
To Building Foundation 7 %' w --To Existing o= Abandoned System ca
Lot /~/WkJ__ ; On Adjoining Lots -~{D ~
To Water Main/Service Line /~ ~- To Cutbank( if p=esent) /~/~ ~_
To Stream/Pond/Lake/c~ Majo~ D~ainage Course /Z/~
To D~iveway, Parking A~ea, or Vehicle Strafe A~ea ,~F~ ~
Date Installed
Size. in Gallons
"Pump On" Level at
High Water Alarm Level at
Di~enslons
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Tested fo=
Electrical Codes(Y/N)
Cc£t¢~-e nt s
Pumping Cycles du=ing Adequacy Test.
~ets MOA
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conf(mT~d to all MOA HAA Guidelines in effect
KB1/dS/s
[Page 2 of 2]
2-15-84
L
)F ALASKA, INC.
form Bacteria
;) BE COMPLETED BY LABORATORY
Analysis shows this Water SAMPLE to be:
r..satisfactory
] Unsatisfactory
1 Sample too long in transit; sample should
not be over 30 hours old at examination to
indicate reliable results. Please send new
sample via special delivery mail.
Date Received
Time Received
Analytical Method:
[] Fermentation Tube
CMembrane Filter
~TF~-~-~-~® 8S 874
POLY PAK (50 SETS) 8P874
06-1220 (b)
Rev. 1983
Lab Ref. No. Result* Analyst
ti,,
i m
J r~
· NO of colonies/1 O0 m[ or NO O~ Positive poroor~$
BACTERIOLOGICAL WATER ANALYSTS RECORD
READ INSTRUCTIONS
BEFORE
COLLECTING SAMPLE
Membrane Filter: Direct Count ........ CoilformllO0ml
Verification: LTB___ BGB
Final Membrane Filter Results ..(,~r~ ' Coilform/10Oml
TNTC = Too Numerous To Count
I DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
I.SPEOTOR INSPECTOR I"SPEOTOR A
MUNICIPALITY OF ANCHORAGe
MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI~I~i~i~.~qM~NTAL PROTECTION
, 825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION AUG 2 5 1981
Telephone 264-4720
RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) davs for processing.
1. P.~ RTY OW~IE R
MA'I LInG A B[~ D-~SS
PROPERTY RESIDENT (If different from above) / ! ~' PH'ONE
2. BUYER
PHONE
MAILING ADDRESS
3, LENDING INSTITUTION
PHONE.
,ILING ADDRESS
4...B~ALTO R/AG ENT ~,.-~ ' ~- PHONE
MAlLei NG ADDRES~S ~/
5. LEGAL DESCRIPTION
6. T~PE OF RESIDENCE
SINGLE FAMILY
[] MUL'r PLE FAMILY
7, WATER SUPPLY
INDIVIDUAL*
[] COMMUN TY
[] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEI~I
~ INDIVIDUAL/ON-SITE'~
[] PUBLIC UTI LITY
-~NUMBER OF~BEDROOMS
[] One Z Four
[] Two Z Five
[~ Three [] Six
Other. ,
ATTACH WELL LOG. A we I log is required for al wells drillea
since June 1975, For wells drilled prior to that Date, g~ve well
depth (attach log if available,)
YEAR ON-SITE SYSTEM WAS INSTALLED,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~ ~/
(90/} ?64 ,!I11
August 28, 1981
Ra lph/Carmon Moody
Star Route 1 Box 3465 Klondike
Chu~]ak, Alaska 9956'1
Subject: T15N R1W c, ..
,,ect~on 18 Lot 299
Approval for the
cannot be granted
completed:
individual sewer and water
unl::i], the following items
fac:i lities
have been
(1) The water analysis needs to be submitted l:o this
office from the Chem Lab, 5633 B Street, for
(2) A well log submitted to this office for our files
and review.
If there are any furLher questions, please call. this
office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Bank of Commerce
Post Office Box 1185 99577
Dolores Oesau
% Red Carpet Greatland
Post Office Box 633 99577