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Home My WebLink AboutTONJESS ESTATES BLK 1 LT 5 ('"~ 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 ~ UPGRADE MAILING ADDRESS ~ DISTANCE TO; IWe'I 106 IAbs°rpt'Onerea D. fling PE~MITNO. Liq. capacity in gallons Inside length Width Liquid depth J Z~O IF HOME.DE: ~ ~ ~ ~ DISTANCE TO; Well Owelling PERMIT NO. ~ DISTANCE TO: I 0 ~ Nearestlothne NO. Of linesI Length of each lineq q Total length o, line~ q T,ench ~id~ inche, Distance ~t,en lines ~ TOp Of tile to lini,h grade 3 Material benea'h file ~8 inches < ~ Type of crib Crib diameter CHh depth Total eff~ti~ ebsorptlon area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller O~stance lo lot hne PERMIT NO. ~ DISTANCE TO: Building foundation Sewer llne Septic tank ! Absorption area(si OTHER Pvc el REMARKS II APPBOVED DATE LEGAL 72-013 (Rev. 3178) by SULLIVAN WATER WELLS P. O. BOX 272° CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 LEGAL D~CRI~ION PE~IT NUMBER t // DEPTH OF WELL / OC~O 7 STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR / o~ O O KIND OF CASING c KIND OF FORMATION: From ~ Ft. to . From __ Ft. to Ft. From '~ Ft. to ^")~" Ft. From __ Ft. to Ft. From Ft. to Ft. From-')~'-' Ft. to ?' ~, Ft. From- ~, Ft. to ~ Ft. From ?c'f Ft. to '~77 Ft. From '7 7 Ft. to ~g~:/ Ft. From __ Ft. to__Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From__.Ft. to Ft. From__.Ft. to Ft. From__Ft. to Ft. ,MUNICIPALITY OF ANCHORAGE From _r'14~ p., ~,...1,, From Ft: to FL From Ft. From Ft. to Ft, From__Ft. to Ft.. From Ft. to.~FL From Ft. From__.Ft. to Ft. ' ' From FI. to.__Ft.. From Ft. to FI From Ft. to Ftr From ' Ft. to : Ft. From FI. to Ft From __ Ft. to__.Ft. From Ft. to__.Ft. From Ft. to.__Ft MISCL INFORMATION: DRILLER'S NAME I--1LII'-~ 'r C 3- PRL -r T"r' OF Rr".ICHOF:RGE DEPRR. TMENT OP' HERLTH RND ENVI,~ONMEIqTRL .P-.,?OTECTION " ~25 'f~'~ STREET, RNCHORRbE, 264-4720 IqEbb Rf4D Ot-~--5 T Ti 5ElqEF-: PEF"['I T P~RMIT NO. ( 820~5~ > RPPLICRHT JOHN SHORT 401 E. 36 RVE LOCRTION JE~ LEE LEGRL L0~BLK 1 Tongess,, Estates S/D TYPE OF SOIL RBSORPTION ~¥S$EM IS: DRRINFIELD LOT SIZE 27~-049i 4~000 SQURRE FEET MRXINUH NUMBER OF BEDROOMS SOIL RRTING (SO FT?BR>= 85 THE REC~UIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DEPTH= 4 LEt'~6TH= 45 6P-.R%.'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE E×CRVRTION <IN FEET>. THE TREI'-,iCH 14 3' DTH T ~,, 5. E'~_.-H~I FEET. THE 6RRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEr.,I THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTIOr.,I (IN FEET>. REf~.U I RED_~EPT I C TAt-II-.<. cs I ZE-- = :I_F_~ £~O 6FILLOtq$ PERMIT RF'PLICRNT HR:"';, THE RESPONSIBILITY TO INFORF1 THIS DEPRRTMENT DURING THE INSTRLLRTION INSF'ECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NLIMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI-lO ( 2 ~', I I'--I_qPECT I Ol'-.l_q RRE F: EL~'~. U I F:;:ED BRCKFILLING OF RNY S'.r'STEr,! WITHOUT FINRL INSPECTION AND RPPROYRL E:Y THIS DEPRRTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC HELL MINIMUH DISTRMCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET fiND TO R COMMUNITY 5EHER LINE IS 75 FEET. HELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITHIM ~0 DRYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE AVRILRBLE T0 INSURE PROPER INSTALLRTION. PERF'"I I T E×P I P-.ES DECEI"IE:ER ~..-1 .. I CERTIFY THRT t: I RM FRMILIRR HITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE 14ITH THE CODES. _'3,: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MR"/ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. V4. 0 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 ..--4 5 6- 7 8 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST K SOILS LO~ [] PERCOLATION TEST / ortjc:. SLOPE Ill II I Itl Ill III III III I/I Yl /I I DATE PERFOR.ED= 5-'-/s~ &,~. SITE PLAN WAS GROUND WATER SL ENCOUNTERED? nh pO 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 CERTIFIED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION la) Application Date ~(~ ~$r 19S6 Legal Description (include lot, block, subdivision, section, township, range) Lot 5~ B~ock I; Ton{e6& E6t~te6 Location (address or directions) lb) Applicant Name £oqe~. G.~e~6o~t Telephone: Home 6SJ-9755 Business Applicant Address SE Box, 6454~ C/tuq~cdz, ALU6~ct 99567 lc) Applicant is (check one): Lending Institution D; Owner/builder 1~1; Buyer I-I; Other I-I (explain); (d) Lending Institution N~:~o;,t~. ~:t~tE o~ A(~¢~,~za. Telephone Address An~ho~a_~.. ~z~ (e) Real Estate Company and Agent ~o~/~~ Address Telephone (s) ,)~the HAAtothefollowingaddress: ~ ~9~X TYPE OF RESIDENCE Single-Family ~:~ Multi-Family[:] Number of Bedrooms 5 Other WATER SUPPLY Individual Well ~ Com.munity D Public r-I Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL · : · Onsite~] PublicD Communityl-I Holding Tank D 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 (t 1,84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION · As certified by my seal atfixed hereto and as of the validation date shown below. I verify Ihat 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 lurther verily 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 compl'ance w'th all Munic'pal and State codes, ord~nances,*and regulations in effect on the date of this insp'c~i°"nENGINEERING Name of Firm Address 'EAGLE RIVEI~'-AK-9~577 Date I tAY 2 9 DHEP APPROVAL ~ //') TA::rmOsV~cond~.~ ~e ne, Appr ova~iSapproveo~ ' ' Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authoriiy Approval certilicates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their tending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 WELL DATA ~'~iUNICIPALITY OF ANCHORAGE HEALTH A~HORITY APPROVAL (H~) DEPT. 0 "- RA~ECKLIST- FEBRUARY 1~ ~A~ ~' '~ P~TE~iON Legal D~ I A¥ 2 9 1988 RECEIVED. Well Classification Well Log Present ~)N) Total Depth ~1 ~7 * Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/l~l/~ank on LOt If A, B, C, D/E.C. Approved (Y/N) Date Completed ~, ,/I~"~..- Yield Casedto ~gP ~'~' Depth of Grouting _~'~'~ ~ Pump Set At [-)'/~'" ~ ~' Sanitary Seal on Casing~l) Depression Around Wellhead (Y.~) I ~"~' ' ; On Adjoining Lots To Nearest Edge of Absorption Field on, Lot ~; On Adjoining Lots % ~=¥,.~' t..%. To Nearest Public Sewer Line ~/ t'~ I/k' To Nearest Public Sewer CleanouUManhole ~-~ To Nearest Sewer Service Line on Lot Water samPle (~ollected by ~'~"~. '~ ~1,.~,(,*,-~--"l~t~ ;Date Water Sample Test Results ~,~"1 ~ I Comments B. SEPTIC/H~'I~TANK DATA Date Installed ~c~,~.{,_~-.~,. Size ~ No. of Compartments ~ Standpipes~¢N) Air-tight Caps~'N) Foundation Cleanout (Y/~ Depression over Tank (Y~ . ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) / /~ ; for ,.,/,,, Holding Tank High-Water Alarm (Y/N) /~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/~4e{~'mg Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field To Stream. Pond, Lake. or Major Drainage Comments Page 1 of 2 72-026{ t 1/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ ~ t ~ TO Building Foundational/~, ! el Lot Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~/N) Date of Last Adequacy Test To Property Line To Water Main/Service Line [~3 I Jr To Stream/Pond/Lake/or Major DrainaDe Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots ""~:> ~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "P~mp Off" Level at /.~ Vent (Y/N) . Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~h~v~j ~r~:~j~{~r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed e~m n ,,~.,~ Date HAY 2 9 1986 Company Date of Payment Amount: $ Page 2 of 2 · APPLIC"'~/T FILLS OUT UPPER HAL/'"ONLY ' pr~.opert/Owner ' ~a L~ ~ · ~,~,.~ Phone Buyer ~' Addrsss Zip ~e Lending Insti~tlon ~ ~/, /// ~ 4H /~I Phone Add;ess Zip Address Zip ~ Holding Tank NOTE: THE INSPE~ION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Date tnspector Inspector Inspector Inspector SE? 8 1982 RECEIVED ( ) DISAPP~OVED ( ) CONDITIONAL APPROVAL' DATE ~"~'~- ( ~ ~// ~ .y:'