HomeMy WebLinkAboutDEER PARK #1 BLK 1 LT 7beer Park #1
Block 1
Lot 7
#051 -042-58
r�' MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street • Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME//
FRQ�'
NEW
GJ
PGRADE
MAILING ADDRES�57 /2
b7
LEGAL DESCRIPTION
^�•/'o /
` f1/./1
/
LOCATION
NO. OF BEDROOMS
Wel
Absorpu
Dwelling
PEfk4! NO. p
�'L-
Uy
DISTANCE TO:
/ /l /
PZ
Manulxtur
Ma : yn�
No. of compartments)
sn
Liy. ci iny�illons
L IF HOMEMADE:
Inside length
Width
Liquid depth
Ox
DISTANCE TO: Well
Dwelling
PERMIT NO.
J t�2
? 4
Manufacturer
Material
Liquid capacity in gallons
O
Wr11l�
I E'
Fou ti
Neaarryysr to mo
N
PER�sh NO.
i
W
DISTANCE TO:
/VJ % �/v
GO • V'
• "Icr
ZNo.
of lines /
Lengthy) e n�„ f-
jJ
Total I h lyl i
Tr itl /r h
Distance betvke linos
N
a
cc
Ton g f, a td linish rade
Y''
M serial bent t stile
Total effecti absorption area
o
GG �/ /
Ste' incnes
Length
Width
lkp[h
PERMIT NO.
W
t7
o F
Type of trib
Crib diameter
Crib depth
Total effective absorption area
W �
W
�
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
J
Class ,7
D P; 1
ICJ
Oniter
Distance to lot line
PERMIT NO.
W
Building fou anon
Sewer line
Septic tank
Absorption areas)3
DISTANCE TO:
OTHER
"44
Il
PIPE MATERIALS
v c -
SOIL TEST RATIN
37
Z zo f �'rr c.71— z
INS LER %p t
PUCE:/71�i Ir P
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REMARKS /
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AP V DATE LEGAL r•wiN�G�li�'
701 IRev. 31781) 1�.•_ �,' __
MUNICIPALITY OF ANCHORAGE
Department^f Health and Environmenta;�Protection
825 Street, Anchorage, AK. .9501
264-4720
h * * * HANDWRITTEN PERMIT
Permit # h_ WELL I. � AND�ON-SITE SEWER PERMIT
Applicant: ��GGfLQA lY u�"tg Mailing Address:360 L�Xqq ls[Ob�t2 i,
Location:,A, Phone Number:
Legal Description: ��%% /y��� Lot Size:
Type of Soil Absorption System Is:
Trench: �_ Drainfield: _, Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: 3_ Soil Rating (sq.ft/br) 450
r� t -
The Required Size of the Soil Absorption System Is:
DEPTH / LENGTH el.S 1 .GRAVEL DEPTH S WIDTH .�To
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 _ 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 departmen
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlar ement if
the residence /is remodeled to include more that 3 bedroom .
Signed: issued by:
ApFdicant 43 r
Date:
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
PERFORMED
LEGAL D
h 1
2-
3-
4-
5-
6-
7 345s7
8-
9-,
10-
11
12-
13-
14-
15-
16
213141516
17-
18-
19-
20-
Comm
7-
18-
19-
20-
COMM
PERFORMED BY:
72-008 (6/79)
)N: �- 7 6
F4 zF1v11"
s1/ -7V
LiCl.Y7 or, ltntc
CG4� ti F^rZr,
ljf�p _/5D1r/e17 Ili
WAS GROUND WATER IA')
ENCOUNTERED? "
IF YES, AT WHAT
DEPTH?
t45 SOILS LOG
❑ PERCOLATION
TEST
DATE PERFORMED: /2- U
Reading
r
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
N
ov
A
r
PERCOLATION RATE /
(minutes/inch)
TEST RUN BETWEEN FT AND
�T
DATE: J 9-1241-S
72-00
Z41-
LeT-T S oaZ, KNDLL-brt-
,Ou sdr a'\r cr r'D92
r> >r'7 £r-
10
Z J� s•oir
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/ b w
1 �• a / e° r 919 �„ m� �./
q A Q
W �� • A� L / h '�,o�- o f I � �
mm �E
.00 fDF d.Ob,OSe6dn'
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of
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o
� � -00•sD .�.aD,rf•sen' � "'-� •ter / ;
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0
cr
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\ '� ` ��/ •.'ham. / J
LL
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p � tc� �" �r c. �Q � %'Q ht � t• .
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-� � � I �, �ti� j^_ • $ Aro •rsF _ 1 M
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� '•1� i I
MUNICIPALITY OF ANCHORAGE `
DEPARTMENT OF HEALTH S 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
Parcel I.D. # o s-/ - 0 y .1 _ S' 8 HAA # H A q4 -OG 15
1. GENERAL INFORMATION
Complete legal description Lot 7; l3tock 1; Deea Pante Subdivlaion 01
114-.K &----
Location (site address or directions) 22639 Oak Kno"
Chugiak, AK
Property owner -- -_Mt. WiMams
Day phone
Mailing address 2472 MokeUo Heighta ptivv
Mahti.nez, CA
94553
Lending agency
Day phone
Mailing address
Agent VoAtene Nicotaysen/ REMAX EAGLE RIVER
Day phone 694-4200
Address 16600 Centeagietd Drive Eaate Riven.
AK 99577
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well XXX
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4.'"- TYPE OF WASTEWATER DISPOSAL:
.� ,•
Individual on-site XXX
12'i
;
Holding tank
Community on-site
Public sewer
vt
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 p+«. void FrOM MOA m
S. 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 stipply
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 5 a S ENGINEERING Phone 6 9 y— a -Cl 7 q
17034 Eagle River Loop Read N0.21
Address EaaleRiver, Alaalr}Q=
Engineer's signature
Date
0
1 RCEE-RT C COWAN
CE -8301'
6. DHHS SIGNATURE lila`�PFC =
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
CAUTION
,'%The. Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Appmval CertificatE`s�ased only upon the representations given in paragraph 5 above by an independent
pfofessfonalengfn�rregisteiedintheStateofAlaska.TheDHHSdoesthisasacourtesytopurchasersofhomes
and their lending institutions In orderto 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 engineees work. --
72m= (P". IM)
ork.ram=(P".IM) a.ci Moira
Sy
% 00
t
CAUTION
,'%The. Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Appmval CertificatE`s�ased only upon the representations given in paragraph 5 above by an independent
pfofessfonalengfn�rregisteiedintheStateofAlaska.TheDHHSdoesthisasacourtesytopurchasersofhomes
and their lending institutions In orderto 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 engineees work. --
72m= (P". IM)
ork.ram=(P".IM) a.ci Moira
®Municipality of Anchorage
• Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: i -1 Px14- 1 ISE P-KJ1/ Parcel I.D.
A. Well Data
T
0 S'/ — 0'f1 -S'8
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level%
SEPARATION DISTANCES FROM WELL TO:
.p.m. 9.p.m.
Septietholding tank on lot 1S " : On adjacent lots 1 %4'
Absorption field on lot ' I A :On adjacent lots 1114
Public sewer main Public sewer manhole/cleanout
Sewer service line Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC(HOLDING TANK DATA
z
o�
W
O W
W
V
p
W
Date installed 19 63 Tank size I oba Compartments Z
Cleanouts Y&) _Foundation cleanout&l) _Depression (YQ
High water alarm (Y4 .� Alarm tested (YM) ej/A
Date of pumping B — 8 — %7 Pumper HiQJ fbo c
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
W 1223 ' F Foundation J' 1
Weil(s) on lot A On adjacent lots
To property line /• Absorption field / c Water main/service line
Surface water/drainage lDD
72-026 (=), Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Sae in gallons Manhole/Access (YIN)
Vent (Y/N)
High water alarm level
'Pump on" level at
Meets MOA electrical codes (YM)
SEPARATION
D. ABSORPTION FIELD DATA
tested
LIFT STATION TO:
at
On adjacent lots Surface water
Date Installed 1.793 Soil rating (GPD/Fl2) 2 37 .1l System type .TIee�/. _
i
.Length r Width So � ' Gravel thickness S' Total depth 7,s' i-�1�t 4r6c
Total absorption area So Cleanout present(l'1+) Depression over field (Yo e—
Date of adequacy test Results(as a1) PASS for 3 Bedrooms
Water levet in absorption field before test a ' After test /9 '
Peroxide treatment (past 12 months) If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot �J�.e On adjacent lots /.rJ ' Property line 1614-
To
e14-
To building foundation /D r f To existing or abandoned system on lot
On adjacent lots .3o'4- Cutbank ^I/e Watermarvserviceline /a'
Surface water oa / Driveway, parking/vehide storage area
Curtain drain 414
E. ENGINEERS CERTIFICATION
I certiy that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on thertateQ/ this inspection.
Signature yr_�
^ /_ Engineer'sName /�'J �S E cT C . Ca u A ✓
Date /d
HAA Fee '$ -360-00
Date of Payment j I-q-CIg
Receipt Number 60q 0 -7 +)
72-026 (-M)• Back
Waiver Fee $
Date of Payment
Receipt Number,
-+ ROEERT C. COWAN i
%' CE -E301
STATE OF ALASKA
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
CONSTRUCTION AND OPERATION CERTIFICATE
for
PUBLIC.WATER SYSTEMS
A. APPROVAL TO CONSTRUCT
Plans for the eonstr0ettorrvr modification of /'J s -344_84,i ' • Z,1, 78 8, 01—k / Pee, Pjek
public water system located
In _Ch"gr,k Alaska, submitted in accordance with 18 AAC 80.100
by 0.T4 Kn./l t/.l.. /%<soc a% - 9, / !/f a IE have been reviewed and are
❑ approved.
® conditionally approved (see attached conditions). /a.ljer-
TITLE DATE
If construction has not starter' •:.;:+ two years of the approval date, this certificate Is void and new plans and
specifications must be submittea 11., r^•::•w and approval before construction.
B. APPROVED CHANGE ORDERS
Change (contract crow no. IN deecrlptive mf"me)
Approved by
Date
Ex1N s: of p/aJ .�r�^T��fJVPs tn< EVpir1L Sap) 30., 199
C. APPROVAL TO OPERATE
The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water
Is made available to the public.
The construction of the ,L eJ C/.:t. •e ^ public
water system was completed on Com+ 12. 'yy (date). The system Is hereby
granted interim approval to operate for 90 days following the completion date.
BY TITLE
• DATE
As -built plans submitted during the interim approval period, or an Inspection by the Department, has confirmed
the system was constructed according to the approved plans. The system Is hereby granted final approval to
operate.
BY Tr
f
1&4101
94 1,•k'
DATE
DISTRIBUTION: 1. WHITE • ENGINEER (Complete Ssotlen C
Z YELLOW • WATER SYSTEM FILE (Complete Se Ion Q
1 PINK • ENGINEERIMUNI.BOROUGH (Complete Soclif+ CI
4L GOLDENROD • MUNI BOROUGH (Complete Section A)
APPLIC NT FILLS OUT UPPER HAL''�ONLY
Time
Property Owner IJ �L4 r J, r (� r i i t ,-� �/ 1 c�
Phone
Date
(�
Mailing Address �C1 L1 -. .0 , �i �, ,iri T ! ,I( ( Zip Code
F
Date
Buyer �f i t r AM-, ...)r
Address ) % O { ( c Y f' /i �. L. - �� r Zip Code 7 )
Lending Institution �Sr!!�� C (%V % %A/`/'�/�
Phone
ll�(.
4 Vi Zip Code
Inspector
Address J UJ
Realty Co. d Agent , t- ,f) .t A �' LK r , _ ;e', r r't l r (;) r r r 7 f:: S C H [ J ... �. ,� 1.-7
Phone
Address ?C -I(. Fr' r1 A ---Zip Coda
u. x�
Legal pescrlDtbn(� ( L k r J .��% Q�K
CEPT, .F H`i :T: t ;
Street Lmatinn / AZ r) P7 -
RECEIVED
( ) APPROVED BEDROOMS
TYpe of Residence
( DISAPPROVED
,U Single Family
DAT 1 1 — 3 e--;� — 3
O Multiple Family No. of Bedrooms
BY C<D• $
❑ Other
Date Sewer Installed
Well To Absorption Area
Water Supply
C Individual
ATTACH WELL LOG. A well log Is required for all wells drilled
since June 1975.
;Q Community
For wells drilled prior to that date, give well depth (attach log
11 available).
❑ Public Utility
Sewer Disposal
FIndividual Year Individual Installed: i
❑ Public Utility When Connected to Public Utility:
G Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
U
��
/[)
Time
Time
Time
Time
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
CEPT, .F H`i :T: t ;
ENVIRO��=NTAL PK.Dj ZION
RECEIVED
( ) APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( DISAPPROVED
( ) CONDITIONAL APPROVAL -
DAT 1 1 — 3 e--;� — 3
BY C<D• $
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
Septic Tank Size
Well to Tank
7202319
Time
APPLY VT FILLS OUT UPPER NAL ONLY
wa —
Time
�AwPS
Time I
`ate
Properly Owaer
A C' RA S # q_?_ Soy '
-P�,.ena
Date
���
Mailing Address
t - �✓— .L Zip Code
�(\
Buyer LJT��i/i/lrSJ WTCL(tl/)1
r
Address
I! 4j _ 1 j ) % F i < LUZ< ZIP Code
Lendlpg Institution
1- . 7 L. ?/I h14_
ASXA eo�Al-iw nI
L✓1
Phone
Address
10 Zip Code (
S -
Realty Co.6 Agent
p
`lPrn ✓IX /1Fntir fCN4�tc Fr7-/—
I
Phone
Address
Qc
)I',, L' u 1 Zip Code / /) 7 1
C
n / '(
Legal Description
1 D'- '? 6 f- re 42 l- X)o . --r
Street Location
A b
RECEIVED
Type or Residence
.�.
Single1 Family
'CONDITIONS OF APPROVAL
�Lj Multiple Family
Multiple
No. of Bedroorre
❑ Other
•
ate( Supplyy.�
❑ Individual G(C. �d1 ny
ACH WELL LOG. A well lop Is required for all wells drilled
log
since June 1975.
If
pp Community
16
M•O l
1
1,or wells drilled prior to that date. Dive wan depth (attach
available).
Public Utility
Sewer Disposal
rf
�C Individual
Year Individual Installed: ?S
Date Sewer Installed
❑ Public Utility
When Connected to Public Utility:
s D
❑ Holding Tank
Septic Tank Size OO
'Z',-7
ef� —C8 _S
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REGUEST BEFORE PROCESSING CAN BE INITIATED.
1'
Time
Time
Time
Time I
`ate
Date
Date
Date
l
Inspector
Inspector
�(\
�ns0
r
Inspector
•,
Field Notes: ��
C�`,'
iJTlI^ A" Ofd P.01.141,1CAG
CPT. OF /.LTH t:
C �TM
0. nf�
p LGA• 1�
1c�K�u"sa9
W EN , �,n' AL FROTECTION
�C C(I�' Vis
co,.
OCT �iJ
RECEIVED
SPP
.�.
( ) APPROVED BEDROO
'CONDITIONS OF APPROVAL
DISAPPROVED
( I CONDITIONAL APPROVAL -
�'�
•
DATE /� .'3,O`.73
BY:-O'`�—Z-
Na7ep.
Soils Rating
Date Sewer Installed
Well To Absorption Area
s D
Welt Loo Recelved
Septic Tank Size OO
'Z',-7
ef� —C8 _S
I Well to Tank 160
1'
rzmr teen
t5.
r.