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Home My WebLink AboutWALTER G PIPPEL ADDITION BLK 8 LT 6 k.~/: MUNICIPALITY OF ANCHORAGE '~" DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION PHONE ~EW LOCATION Well t Absorption area D,STANCETO, I IF HOMEMADE: Inside length Dwelling IWidth NO. OF BE.?~OOMS PERMIT NO, No. of compartments ~_~ Liquid depth PERMIT NO, Well DISTANCE TO: Manufacturer Liquid capacity in gallons PERMIT NO. D,STANOETO: ILengt f ach'ina No, of lines j Material/~ ~ . Nearest lot line Trench w'dth Length Foundation .~/~ Total length of lines ~/~ Material beneath tile Depth Top of tile to finish grade Width Distance between lines Total effective absorption area PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area WelJ Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS SOl L TEST RATING REMA KS APPROVED 72-013 (Rev. 3/781 DATE LEGAL PERMIT N0. DEPFIR'FMENT OF ~tEFILTH ~ND ENVIRONMENTFIL PROTECTION ~5 "L~' STREET, ANCHORAGE, AK. 264-4720 C)1".-4--5 I 1-E SE~.Zi..IEF~ 788287 ) RPF'L ! CRNT LOCRT I ON LEGRL CLIFFORD PRICE PO BOX CORNER OF ERSY ST & ALIRORR ST L6 88 WRLI'ER PIPPLE 78 ERGLE RIVER LOT SIZE 694 9129 ±3770 SQURRE FEET TYPE OF SOIL AEJSORBTION SYSTEM IS: ]'RENCH PIRXIMUM NUflDER OF DEDRUOM.~ = 3 SOIL RRTING <SQ F'T/DR>= 150 THE REQUIRED SIZE OF THb7 SOIL RBSORPTION SYSTEM ILS: THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PI'F IS THE DISTRNC:E E:ETWEEN THE SURFHCE OF THE OROUND RND THE BOTTOM OF Tt4E EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTIt OF GRRVEL BE'TI4EF_N THE OUI'FI-~LL F'IPE RND THE DOT'rOM OF THE EXCR'v'RTICN (IN FEET). PERMIT RF'PLICFINT HRS THE RESPONSIBILITY TO INFORM THIS. [:'EPRRTMENT DLf-~INGI ' " 'rile INSTRLLRTION INSPECTIONS OF RNY 14ELLS RDJRCENT TO THIS PROPERI'Y RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI,,IO ,C 2 7, Z ~-~--C.F't=---.L~-r I C-~DJS RF:EZ F_' E,L..-~IJ I F:EZD DRC:KFILLING OF RNY 'SYS'TEH WITHOUT FINRL INSPECTION RND RF'PROVRL DY THIS DEF'FIRTMENT WILL BE SUB.TEC:T TO PROSECUTION. MINIMUM DIS'FRNCE BETWEEN R WELL RND ANY ON-SI'rE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVR'rE WELL¢ OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING LIPON THE TYPE ElF PUBLIC HELL OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIFtGRRM2; RRE RVRILRDLE TO INSLIRE PROPER INSTRLLRTION. PEIRI-'I I T EXP I F;P. ES PEC:E~'IE'~EF: -.> ~L., I CERTIFY THBT 1: IRM FRMILIRR WITH FORTH BY THE /tUNICIPRLITY OF RNC:HORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITtt THE CODES .... D: I UNDERSTRND 'FHRT THE ON-SITE SEWER SYSTEM Miry REQUIRE ENLRROEMENT RESIDENCE IS REMODELED TO INCLUDE MORE THRN 2< BEDROOMS. THE REQLIREMENFS FOR ON-SITE SEHERS RND WELLS Ri; SET IF THE V~. 2 2204 Cleveland Anchorage, Alaska 99503 Performed For Clifford Price Date Per¢ormed Le~al qescrtntton: Lot This Form Renorts Sotls 3,-,~ l -78 . 6 Block~_~__$ubd'lvi$ion Walter Pipple SubdivisiD~n Loft Yes ,Percolation Test_ Peoth Feet Sot1 Characteristics Reddish Silt ~ Brown Sandy Gravel with trace of Silt (Occasional cobbles) 10-- 12-- 14-- 16'-- 18-- Bottom of Test Hole 20-- Was Ground Water Encountered/ No ~/_ I~ Yes, At what Depth? Depth to H20 Net Dron Readtnq Date Grnss Ttme Net Time i ' Percolation Rate tlt nute Prnposed Installation': Seeoaae Pit Drain Field Deoth of Inlet ~Oep~om Of Pit 6n~M£NTS: 150 Sq. ~--. drainage arena required, er bedroom. 8y .' CTL ~ 3-31~78 Date. ~v~b~r 7, HFFL] _4 NF RFILENE F'R I E:E_ -'l ...... ~'-' FI. LOCFI]" I EIN r'_n_ m .=,. LEGRL LT. 6BK. 8 PIF'PLE S/g' LOT SIZE 2.4¢88 SQURRE FEE]' MiNIFIU[4 DI$"f'FINCE BETWEEN FI WELL RND RN"¢ ON-SITE SEWFtGE DISPOSRL S'¢c;]'EP1 :~.E~O FEE]' FOR FI PRIVRTE WELL OR 2R8 FEET FOR R PUBLIC WELL. WELL LOGS RRE REQUIRED FIN[:' MUST BE RETURNED TO THE DEPRRT['IEN]" WITHIN ]~:E~ OF ]-HE WELL COf'IPLETION. OTHEFI REg!UIREP1ENTS MR"? RPPL"r'. SPECIFICRTIONS RND CONSTRUCTION [:'iRGRRI"IS RFIE R',,,'R:[LRBLE TO INSURE PROPER INSTRLLRTION. I (::EFITIF'¢ 'THRT 1: I RM FRFIILiRR WITH THE F-'.EL~UIFIEf'IEN-I"S FUF~. ON-SITE -,EIJE~.¢ RN[:' WELLS FORTH B'¢ THE PII_INICZF'RLZT'¢ OF' RNZ:HORROE. ~":". I WILL 'IN- IHI-L' c; .... ]'HE '-'= ~-TEtl '~ -' iN la-"F'ORDRNE:E_._. ['lI"l"H THE L.U[-'E"' "' .... S ~ GNffg,: ............................... ~PF'L I C~NT ~.~E PFI I C~ I SE;UE[' E,~ -.-~---~ ...................... OWNER OF LAND LEGAL DESCRI~iON DATE-Started ~/~/T? Ended PE~ITNUMBER 7 77 DEFTa OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT, GALS. PER HR ./~o KIND OF CASING ~O KIND OF FORMATION: From 0 Ft. to / Ft. O O~g~of~O- _ £,o_ ' From From I Ft. to q Ft. ~--,q,047 ~,¢ ~p~j~ a ~ From__ From ~[ Ft. to~Ft. Ct~ g ~o~c From From 4/'C Ft. to ,~& Ft. ~ C~/:4 ~' ~'T~om From Ft. to _Ft. From From.~Ft. to Ft. From~ From. Ft. to_ Ft. From~ From Ft. to Ft._ From~ From Ft. to Ft~ From~ F~m~.Ft. to Ft. From__ From Ft. to Ft., From From Ft. to.__Ft. From From Ft. to Ft, From From Ft. to Ft. From ~ From Ft. to Ft. From__ From __ Ft. to Ft.. From~ From Ft. to Ft._ From_ Ft. to Ft. Ft, to_ Ft. Ft. to___.Ft. Ft. to Ft, Ft. to Ft Ft. to Ft. .Ft. to Ft. .Ft. to .Ft. · Ft. to Ft. .Ft. to Ft. Ft. to Ft. Ft. to.--Ft. Ft. to Ft. .Ft. to Ft, .Ft. to Ft. _Ft. to Ft. Ft. to__FL MISCL. INFORMATION: DRILLER'S NAME .,2. M~ ,- ~ · Parcel I.D. # 1. 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 0 ,~-'0 -- I'~,~ --O ! : HAA# GENERAL INFORMATION Complete legal description Lot 6; Block 8; WoG. Pipple Addition #1 Location (site address or directions) pj~bl~'et~y:,bwner ' cti~ s Mailing.address.: ..... 17137 E.~r~d(fig agency M~iiing address .' ' ',~ Agen{' Mike Cia.ramitaro/Greatl~nd Realty 17137 Easy Street Eagle River, AK 99577 & Arlene Price Day phone Easy Street Eagle River, AK Day phone 99577 Day phone 694-9125 Address NUMBER OF BEDROOMS: Unless otherwise requested, HAA will be held for pickup. 3 TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water xxx If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ×x× 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 #2! STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that ~y 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 S & ~; ENGINEERING t,u;~4. Eagle I~iver Loop Road No. 204 Address Eagle River, A, laska 995..~77 Phone Date DHHS SIGNATURE "~ Approved for ..3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: ~~"~ '~ Date y////~-'-__ 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) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authdrity Approval Checklist Legal Description:z'°''T (~ ~L~c~-- ~ Parcel I.D.: t~.-~-. P,/'?'--~_ ~a~ ~-/ A. WELLDATA ~'J~t c ~ V~ell type Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production D_~ple: 0$~° - I ~?,.o/ If A, B, or C, attach ADEC letter. ADEC water system number Date completed j ~, ,~. Cased to _ __ Casing height (ab..ov~ground) Wires pro~pro'tected (Y/N _)~ ------ y '' _.. '~"?., '~,,, ~-~ FROM WELL LOG /AT INSPECTION (~, J g.p.m, g.p.m. Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~o//? ~ Tank size / o o O Number of Compartments ;L C eanouts (~N). Foundation cleanout ~/N) ~ V,~$ Depression (Y~) /v 0 High water alarm (Y/~ /,~ o Date of p u m;p, ih~ ,f ~b'~.~/5~" ./~ .~,~.,: '~:,.~p um per 3--,~. C. ABSORPTIO~N.FIELD;DATA. ' "' ', · ~. ..' ,.. , ;;...~., .'~ Date insta~ll~t'' '~'] '~ ¢ ' Soi'l rating (g.p.d./fF or~ ! ,~'-o System type T-~¢~' Length ~3 F',, Width ?t '~t~' Gravel thickness below pipe c/(~ Total depth ) Effective absoYp~tion area ~ ff~.. '~ onitoring Tube present (~YN)¥~ J~ Depression over field (Y~ ~ o Date of adequacy te~ (o / ~L/ //~t 7 Results (Pass/Fail) f~ 4- -(J' For 3 bedrooms Fluid depth in absorption field before test (in.); '~-.~ ~1 Immediately after Z2~gal. water added (in.): Fluid depth ~O (ins) Minutes later: ~ ~ ~ Absorption rate = -~,CO ~ .g.p.d. Peroxide treatment (past 12 months) (Y/N) ~o~v ¢ ~ ,~o ,~ ~ If yes, give date ~-- 72-026 (Rev. 3/96)* D, LIFT STATIO~N ~. Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Size in gallons "Pump on~ "Pump off" level at*. On adjacent lots On adjacent lots Public sewer manhole/cleanout /¢~) / Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK ON LOT TO: Foundation g ~ 'P Property line ~' ~ Absorption field ~ f ~ Water main/service line /0J~' Surface water/drainage t.no/¢' Wells on adjacent lots /¢:~W- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation /0'''¢' Water main/service line ,/~/'/' Driveway, parking/vehicle storage area / d / ~ ~Ou'~z,J,"J Wells on adjacent lots /d~/¢' ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal~ in conformance with MOA HAA.~luideljnes in effect on this date. j' ¢ Signature ~L:/(- ~ .~..~, Engineer's Name J2od4/b~- (._' ("O,~.,~-,/,.~ [~ - - - Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number SEP- 9-97 TUE 9:04 ~B~IU ~ MUNICIP.~LITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907)564-2762 Fh:~ NO, 9075625427 P,U~ WATER CONNECT PERMIT 97-5735 DATE OF APPLICATION 09105/97 SCHEDULED COMPLETION DATE 12~9~- - ' - BLOCK/LOT/TRACT BLK 8 LT 6 SUBDIVISION WALTER G PIPPEL ADDITION TAX CODE 5012401 GRID STREET ADDRESS 17137 EASY ST NW0252 AS-BUILT ~, SINGLE FAMILY I j MULTI-DWELLING No. APTS L I COMMERCIAL OWNER PRICE CLIFFORD A & ARLENE L MAIL ADDRESS 17137 EASY ST EAGLE RIVER, AK 99577 ~ONTRACTOR CCC CONTRACTING Repair Existing Service On Property Only Hydrant Only Main Tap -To Property Line Only Main Tap & On Property Connect Disconneat R & R - Main Tap Only ','-'1 City Tap ;"'] 50' or Longer Row No, CONNECT SIZE REIMBURSABLE NUMBER REMARKS iNSPECTION FEE $, 103,00 PERMIT FEE $ 45.20 $ 0 00 DEPOSIT $ 0.00 TOTAL $ 14820 PHONE ASSESSMENTS Main Line Extension ~:,Have Been Levied C~momTO Be Levied iSSUED gkrolke ' OTHER NSPECTED BY PERMITTEE (Please Print) MAIL ADDRESS ,, -- .... PHONE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Original SEP-,9-97 TUE 9;03 flWWU FfiX NO. ~U/bU~54~ ~.u; DATE SCHEDULED TIME INSPECTOR SUBI~IVISION WALTER G PIPPEL ADDITION I~LOGK/LOT/TRACT BLK 8 LT 6 I I I I " ~DOMESTIC ONLY ~ BOTH FIRE & DOMESTIC SIZE CONN / CORP. STOP ~ FIRE LINE ONLY ~ FIRE HYD~NT ONLY ..... ~ ..... & ,,yo.~ ~.~o~ -..~,. 2// ~.o. .... c~' ~ ............ ~t ~THAW-WIRE~ DISCONNECTS ~YES ~ NO ~.~<~.SlZEOFDISCONNECT KEY BOX LOCATION ~ ~ ~ KEARNY CONNECTOR ...... ~ ..... ~_~ ........... .~./_.~,. ,.. _,_ .,~.. ......... ~ ............ OTHER INSPECTION REPORT ~ K.~,&.T,W.-OKAFTfiR~ACK-FILL DATE ~ /~ / ~ ~ OPEN BOREFLUS~ ..... / / ~ COMMENTS ~ ~ 200 LB, TEST I I ' ~ .MAIN CHLORINATED / / Post-i~ F~x Note 767~ ~OKTO TURN-ON ~ DO NOT TURN-ON ~JDept